Individual
JERRY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1067 PR 2262, GIDDINGS, TX 78942-6171
(979) 542-4572
Mailing address
PO BOX 600, GIDDINGS, TX 78942-0600
(979) 542-4572
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
11342
TX
Other
Enumeration date
05/28/2015
Last updated
05/28/2015
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