Provider Demographics
NPI:1750153946
Name:ANDERSON, SHARAI T (LMHC)
Entity type:Individual
Prefix:
First Name:SHARAI
Middle Name:T
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 BRIGHT SKY RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8889
Mailing Address - Country:US
Mailing Address - Phone:575-642-4692
Mailing Address - Fax:
Practice Address - Street 1:2360 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4609
Practice Address - Country:US
Practice Address - Phone:575-642-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM393659101YS0200X
NMCTB-2023-0810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool