MEDICARE: DR. CAROLYN ANDERSON PH.D.

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	103TC1900X	Counseling Psychologist	25632	TX

General Provider Information

NPI Number	:	1720296619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN ANDERSON PH.D.

Provider Business Mailing Address
First Line	:	1011 AUGUSTA DR
Second Line	:	#107
City	:	HOUSTON
State	:	TX
Zip	:	77057-2062
Country	:	US
Telephone Number	:	713-914-9944
Fax Number	:	713-914-9599

Provider Business Practice Location Address
First Line	:	1011 AUGUSTA DR
Second Line	:	#107
City	:	HOUSTON
State	:	TX
Zip	:	77057-2062
Country	:	US
Telephone Number	:	713-914-9944
Fax Number	:	713-914-9599

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/29/2010

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Directions to “ DR. CAROLYN ANDERSON PH.D.” Practice Location

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