Individual
LEELLEN LOU ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LASAC
Contact information
Practice address
2002 N STOCKTON HILL RD, KINGMAN, AZ 86401-4698
(928) 718-4800
(928) 718-5666
Mailing address
3710 N IRVING ST, KINGMAN, AZ 86409-3117
(928) 718-4800
(928) 718-5666
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LASAC 13268
AZ
Other
Enumeration date
01/09/2013
Last updated
01/09/2013
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