MEDICARE: JEFFREY ANDERSON CADC-CS, ICCS, ICADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1891151015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ANDERSON CADC-CS, ICCS, ICADC

Provider Business Mailing Address
First Line	:	555 S PALM CANYON DR STE A202
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-7210
Country	:	US
Telephone Number	:	760-892-4538
Fax Number	:	760-318-0610

Provider Business Practice Location Address
First Line	:	555 S PALM CANYON DR STE A202
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-7210
Country	:	US
Telephone Number	:	760-892-4538
Fax Number	:	760-318-0610

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	03/17/2018

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