Provider Demographics
NPI:1487492062
Name:JEFFERY ANDERSEN, LMFT
Entity type:Organization
Organization Name:JEFFERY ANDERSEN, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF ARTS
Authorized Official - Phone:831-278-1056
Mailing Address - Street 1:3500 LAKESIDE CT STE 212
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4896
Mailing Address - Country:US
Mailing Address - Phone:775-453-4105
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT STE 212
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4896
Practice Address - Country:US
Practice Address - Phone:775-453-4105
Practice Address - Fax:775-981-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist