MEDICARE: JONATHAN F. ANDERSON MA, LPC-S, LCMHC

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	174400000X	Specialist	MT044204	TX
2	101YP2500X	Professional Counselor	16807	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629114780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN F. ANDERSON MA, LPC-S, LCMHC

Provider Business Mailing Address
First Line	:	3939 BEE CAVES RD STE A203
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6429
Country	:	US
Telephone Number	:	512-771-7621
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 BEE CAVES RD STE A203
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6429
Country	:	US
Telephone Number	:	512-771-7621
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/05/2022

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