Provider Demographics
NPI:1538448204
Name:ANDERSON, JARED (PHD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 S CEDAR CREST CT STE 200
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6993
Mailing Address - Country:US
Mailing Address - Phone:816-785-3187
Mailing Address - Fax:
Practice Address - Street 1:303 JUSTIN HALL
Practice Address - Street 2:KANSAS STATE UNIVERSITY
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66506-1400
Practice Address - Country:US
Practice Address - Phone:785-532-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016495106H00000X
KS2854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist