Individual
TERRY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, MSW, DMIN, LCSW
Contact information
Practice address
300 W WAYNE ST, FORT WAYNE, IN 46802-3608
(260) 422-8556
(260) 422-8558
Mailing address
300 W WAYNE ST, FORT WAYNE, IN 46802-3608
(260) 422-8556
(260) 422-8558
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
34003367A
IN
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34003367A
STATE LICENSE
IN
Enumeration date
06/18/2007
Last updated
11/15/2007
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