Individual
THOMAS RANDALL ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
103 RUBY LN, CRESTVIEW, FL 32539-7341
(850) 682-1903
(850) 682-8689
Mailing address
3997 STEWART LAKE RD, CHIPLEY, FL 32428-7319
(866) 325-5434
(866) 325-5340
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6519
FL
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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