1407859465 NPI number — TRACIE L ANDERSON LCSW

Table of content: TRACIE L ANDERSON LCSW (NPI 1407859465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407859465 NPI number — TRACIE L ANDERSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
TRACIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407859465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-282-1888
Provider Business Mailing Address Fax Number:
812-218-9318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-282-1888
Provider Business Practice Location Address Fax Number:
812-218-9318
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34000315A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 807 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2767013000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 82900176 . This is a "MEDICAID KENTUCKY GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 160780 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000056294 . This is a "ANTHEM GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2444451000 . This is a "PASSPORT GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 160860 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 8200076100 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000226075 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264003000 . This is a "BR BUTLER'S MIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50704000 . This is a "MAGELLAN GROUP MIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CG3623 . This is a "INDIANA RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100386460 . This is a "INDIANA MEDICAID GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1518960681 . This is a "DR BUTLER'S NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800012510 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 78903689 . This is a "MEDICAID KENTUCKY GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 94882000 . This is a "MAGELLAN MIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200319860A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65927857 . This is a "MEDICAID KENTUCKY GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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