Provider Demographics
NPI:1487414199
Name:ANDERSON, CHAYNE KURTIS (LMFT)
Entity type:Individual
Prefix:
First Name:CHAYNE
Middle Name:KURTIS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 PITTSBURGH PIKE
Mailing Address - Street 2:
Mailing Address - City:RUFFS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:15679-1441
Mailing Address - Country:US
Mailing Address - Phone:724-989-1806
Mailing Address - Fax:
Practice Address - Street 1:102 N 3RD ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:PA
Practice Address - Zip Code:15089-1530
Practice Address - Country:US
Practice Address - Phone:724-989-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist