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NPI Code Detail

MEDICARE: BILLY M ANDERSON LICSW, LADC, LPCC

MEDICARE: BILLY M ANDERSON LICSW, LADC, LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker12688MN
2101YP2500XProfessional Counselor379MN
3101YA0400XAddiction (Substance Use Disorder) Counselor300215MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1347720700OTHERMNMEDICAL ASSISTANCE

General Provider Information

NPI Number : 1033286414
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLY M ANDERSON LICSW, LADC, LPCC
Provider Business Mailing Address
First Line : 1501 XERXES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2851
Country : US
Telephone Number : 763-522-0100
Fax Number :
Provider Business Practice Location Address
First Line : 1501 XERXES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2851
Country : US
Telephone Number : 763-522-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 01/30/2026

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