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KEITH A ANDERSON MSW

Behavioral Health & Social Service Providers Counselor Mental Health

Provider NPI: 1982863312

Provider Information:
 KEITH A ANDERSON MSW
Gender: M
Not Sole Proprietor

Practice Location:
403 E MADISON ST  SOUTH BEND, IN 46617-2322 US
Tel: 574-283-1234  Fax: 574-537-2652

Business Mailing Address:
PO BOX 809  GOSHEN, IN 46527-0809 US
Tel: 574-283-1234  Fax: 574-537-2652

NPI Information:
NPI: 1982863312
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
IN34006132A

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 1041C0700X

Type:

Classification:



Definition:



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