MEDICARE: MS. MAJA-LISA C ANDERSON MA, PC

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	C.0600190	OH
2	101YP2500X	Professional Counselor	C.0600190	OH

General Provider Information

NPI Number	:	1295030864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAJA-LISA C ANDERSON MA, PC

Provider Business Mailing Address
First Line	:	680 PARK AVE W
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3706
Country	:	US
Telephone Number	:	419-528-5993
Fax Number	:	567-560-5486

Provider Business Practice Location Address
First Line	:	680 PARK AVE W
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3706
Country	:	US
Telephone Number	:	419-528-5993
Fax Number	:	567-560-5486

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

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	07/31/2025

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