MEDICARE: ANDERSON THERAPY GROUP PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1548892672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON THERAPY GROUP PLLC

Provider Business Mailing Address
First Line	:	PO BOX 558
Second Line	:
City	:	COSMOPOLIS
State	:	WA
Zip	:	98537-0558
Country	:	US
Telephone Number	:	360-612-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W 4TH ST STE 103
Second Line	:
City	:	ABERDEEN
State	:	WA
Zip	:	98520-3932
Country	:	US
Telephone Number	:	360-612-0456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMANDA N ANDERSON
Credential	:	PHD
Telephone Number	:	360-500-1704

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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