Individual
DR. TERENCE NEAL ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
318 PINE LAKE AVE, LA PORTE, IN 46350-3061
(219) 324-6263
(219) 324-6263
Mailing address
318 PINE LAKE AVE, BOX 668, LAPORTE, IN 46352-0668
(219) 324-6263
(219) 324-6263
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20010366 HSPP
IN
103TC0700X
Clinical Psychologist
20010366 HSPP
IN
103TH0100X
Health Service Psychologist
Primary
20010366 HSPP
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183576
BLUE CROSS
IN
01
—
010676
VALUE OPTION
IN
Enumeration date
10/18/2006
Last updated
01/07/2008
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