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MS. JILL LOUISE ANDERSON PSYD
>> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1386805661
Individual Registrant:MS. JILL LOUISE ANDERSON PSYD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
2400 BRIDGEWAY SAUSALITO, CA 94965-2850 US
Tel: 415-272-6850 Fax: --
Tel: 415-272-6850 Fax: --
Contact information for business:
PO BOX 204 SAUSALITO, CA 94966-0204 US
Tel: 415-272-6850 Fax: 415-664-7094
Tel: 415-272-6850 Fax: 415-664-7094
Registration Information:
NPI: 1386805661
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101Y00000X | Behavioral Health & Social Service Providers Counselor | ||
| N | 103T00000X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 390200000X | Student Organized Health Care Education/Training Program | ||
| Y | 103TC0700X | Behavioral Health & Social Service Providers Psychologist | CA | 31904 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
