MEDICARE: DR. MARK CHRISTOPHER ANDERSON PHD

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	103TB0200X	Cognitive & Behavioral Psychologist	PY0489	NV
2	103TC0700X	Clinical Psychologist	PY0489	NV
3	103TC0700X	Clinical Psychologist	013030	NY

General Provider Information

NPI Number	:	1801951579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK CHRISTOPHER ANDERSON PHD

Provider Business Mailing Address
First Line	:	2620 REGATTA DR
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6891
Country	:	US
Telephone Number	:	702-363-6429
Fax Number	:	702-925-8747

Provider Business Practice Location Address
First Line	:	2620 REGATTA DR
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6891
Country	:	US
Telephone Number	:	702-363-6429
Fax Number	:	702-925-8747

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

Provider Enumeration Date	:	12/23/2006
Last Update Date	:	09/11/2025

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