Individual
MR. TIMOTHY JAMES ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSLMFT
Contact information
Practice address
7251 EXCELSIOR RD, BAXTER, MN 56425
(218) 232-6067
(218) 454-0879
Mailing address
7251 EXCELSIOR RD, BAXTER, MN 56425-8477
(218) 454-0878
(218) 454-0879
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2900
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2900
MINNESOTA STATE LMFT NUMBER
MN
01
—
L642115036912
DRIVERS LICENSE NUMBER
MN
Enumeration date
01/12/2016
Last updated
01/12/2016
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