Individual
MR. GREGORY T ANDERSON
Active
Individual
MR. GREGORY T ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP1457
MN
1041C0700X
Clinical Social Worker
7341
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024 R1LA
BLUE CROSS/BLUE SHIELD
MN
01
—
1016110
PREFERRED ONE BHP
MN
01
—
106621
U CARE
MN
01
—
46092
OPTUM
MN
01
—
62-21313
MEDICA / UBH
MN
05
—
943752500
—
MN
Enumeration date
08/23/2006
Last updated
05/24/2012
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