MEDICARE: MR. ANDREW IAN ANDERSON MA LMHC INTERN

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	28359	FL

General Provider Information

NPI Number	:	1316870678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW IAN ANDERSON MA LMHC INTERN

Provider Business Mailing Address
First Line	:	3148 BORDER CREEK RD
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-9061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 BAYOU BLVD STE 34
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2682
Country	:	US
Telephone Number	:	850-760-2300
Fax Number	:	833-895-1385

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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