MR. JEREMY RUSSELL ANDERSON LPC NPI 1003946369

NPI Information

NPI: 1003946369
Provider Name: MR. JEREMY RUSSELL ANDERSON, LPC
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
1815 PLEASANT GROVE ROAD
JONESBORO, AR
ZIP 72401
Phone: (870) 933-6886
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MR. Jeremy Russell Anderson, LPC is a mental health counselor in Jonesboro, AR. MR. Jeremy Russell Anderson, LPC NPI is 1003946369. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1815 PLEASANT GROVE ROAD
JONESBORO, AR
ZIP 72401-870
Phone: (870) 933-6886
Fax: (870) 933-9395

The enumeration date for this NPI number is 3/6/2007 and was last updated on 2/12/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	P1307080	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5WW07	OTHER	ARKANSAS	BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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