Individual provider · NPI-1

Dr. Keith J Andersen, Ph.D.

Psychologist, Cognitive & Behavioral · Bishop, CA

NPI number1275558694
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1275558694
Entity type
Individual (NPI-1)
Name
Dr. Keith J Andersen
Credential
Ph.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jul 13, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103TB0200X Psychologist, Cognitive & Behavioral14114CAYes

Practice location

152 Pioneer Ln Ste H
Bishop, CA 93514-2563

Phone 760-873-6712 · Fax 760-873-6712

Mailing address

Po Box 873
Bishop, CA 93515-0873

Phone 760-873-6712 · Fax 760-873-6712

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