MEDICARE: MRS. ELIZABETH ANDERSEN MS, LMHC

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
1	101YM0800X	Mental Health Counselor	MH12800	FL

General Provider Information

NPI Number	:	1063787943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANDERSEN MS, LMHC

Provider Business Mailing Address
First Line	:	4435 DEEP RIVER WAY E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-7585
Country	:	US
Telephone Number	:	904-806-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000A SAWGRASS VILLAGE CIR
Second Line	:	SUITE 12
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5011
Country	:	US
Telephone Number	:	904-806-1197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	05/28/2015

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