Provider Demographics
NPI:1427400738
Name:ANDERSON-LABRANCH, JANEISHA (PHD, LMFT, MS)
Entity type:Individual
Prefix:
First Name:JANEISHA
Middle Name:
Last Name:ANDERSON-LABRANCH
Suffix:
Gender:F
Credentials:PHD, LMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6390
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0390
Mailing Address - Country:US
Mailing Address - Phone:817-716-3596
Mailing Address - Fax:
Practice Address - Street 1:600 STRADA CIR STE 214
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3209
Practice Address - Country:US
Practice Address - Phone:817-716-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202316101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
TX101YA0400X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171400000XOther Service ProvidersHealth & Wellness Coach