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NPI Code Detail

MEDICARE: MR. JUSTIN TAYLOR ANDERSON LCSW, LCDCI

MEDICARE: MR. JUSTIN TAYLOR ANDERSON LCSW, LCDCI
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
1104100000XSocial Worker66646TX
21041C0700XClinical Social Worker66646TX

General Provider Information

NPI Number : 1154999738
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN TAYLOR ANDERSON LCSW, LCDCI
Provider Business Mailing Address
First Line : 2323 POLK ST APT 204
Second Line :
City : HOUSTON
State : TX
Zip : 77003-4407
Country : US
Telephone Number : 832-477-0547
Fax Number :
Provider Business Practice Location Address
First Line : 2323 POLK ST APT 204
Second Line :
City : HOUSTON
State : TX
Zip : 77003-4407
Country : US
Telephone Number : 832-477-0547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2021
Last Update Date : 06/25/2021

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