Provider Demographics
NPI:1053407635
Name:ANDERSON, CHRISTIAN (CPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 LAKEPORT DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-6048
Mailing Address - Country:US
Mailing Address - Phone:775-299-9906
Mailing Address - Fax:
Practice Address - Street 1:380 COURT ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3158
Practice Address - Country:US
Practice Address - Phone:915-779-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20065101YP2500X
NVCP0001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743025435OtherTRICARE
NMNM600035OtherVALUE OPTIONS
NV100516741Medicaid
TX84839LOtherBCBS OF TEXAS
TX1784936-01Medicaid