Basic Information
| Provider Information | |||||||||
| NPI: | 1497806913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | E | ||||||||
| MiddleName: | JAYE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ANDERSON | ||||||||
| OtherFirstName: | E | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20 KINGSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254392897 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2311 LOVERIDGE RD | ||||||||
| Address2: | 2ND FL. | ||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312634 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 23818 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.