MEDICARE: DR. ANSON L SERVICE SR. PSY.D., LMHC

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	101Y00000X	Counselor	LH60413305	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831511849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANSON L SERVICE SR. PSY.D., LMHC

Provider Business Mailing Address
First Line	:	717 NE 61ST ST
Second Line	:	#202
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8753
Country	:	US
Telephone Number	:	360-718-6548
Fax Number	:	360-718-6554

Provider Business Practice Location Address
First Line	:	717 NE 61ST ST
Second Line	:	#202
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8753
Country	:	US
Telephone Number	:	360-718-6548
Fax Number	:	360-718-6554

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

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	04/14/2017

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Directions to “ DR. ANSON L SERVICE SR. PSY.D., LMHC” Practice Location

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