Individual
DR. JUSTIN O'NEAL ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1015 S 4TH ST, LOUISVILLE, KY 40203-3207
(502) 272-9718
Mailing address
1015 S 4TH ST, LOUISVILLE, KY 40203-3207
(502) 272-9718
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1732
KY
103TC0700X
Clinical Psychologist
Primary
1723
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46-2967720
TAX ID
—
Enumeration date
09/19/2008
Last updated
06/29/2021
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