MEDICARE: MS. JOAN MARIE ANDERSON M.S., LPC

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	101YM0800X	Mental Health Counselor	9292	TX

General Provider Information

NPI Number	:	1760416846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN MARIE ANDERSON M.S., LPC

Provider Business Mailing Address
First Line	:	2525 WALLINGWOOD DR
Second Line	:	BLDG. 9, STE. 900
City	:	AUSTIN
State	:	TX
Zip	:	78746-6900
Country	:	US
Telephone Number	:	512-732-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 WALLINGWOOD DR
Second Line	:	BLDG. 9, STE. 900
City	:	AUSTIN
State	:	TX
Zip	:	78746-6900
Country	:	US
Telephone Number	:	512-732-2686
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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