MEDICARE: MRS. BRANDI ANDERSON LMLP-T

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	103TC0700X	Clinical Psychologist	03281-T	KS

General Provider Information

NPI Number	:	1760244933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI ANDERSON LMLP-T

Provider Business Mailing Address
First Line	:	1624 N ROBIN CIR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-5836
Country	:	US
Telephone Number	:	316-371-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 W CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-3315
Country	:	US
Telephone Number	:	316-221-2661
Fax Number	:

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

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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