MEDICARE: CARL ANDERSON

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	101YP2500X	Professional Counselor	C.1300782	OH

General Provider Information

NPI Number	:	1750823811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL ANDERSON

Provider Business Mailing Address
First Line	:	1535 GEORGESVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3615
Country	:	US
Telephone Number	:	614-870-6670
Fax Number	:	614-870-6685

Provider Business Practice Location Address
First Line	:	1535 GEORGESVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3615
Country	:	US
Telephone Number	:	614-870-6670
Fax Number	:	614-870-6685

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

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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Directions to “ CARL ANDERSON ” Practice Location

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