Provider Demographics
NPI:1962101634
Name:ANDERSON, LASHON J (PHD PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:LASHON
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:
Credentials:PHD PSYCHOLOGY
Other - Prefix:DR
Other - First Name:LASHON
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD PSYCHOLOGY
Mailing Address - Street 1:5611 TALL PINES WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4604
Mailing Address - Country:US
Mailing Address - Phone:318-773-2945
Mailing Address - Fax:
Practice Address - Street 1:9403 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3815
Practice Address - Country:US
Practice Address - Phone:318-861-8938
Practice Address - Fax:318-862-3554
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X, 103T00000X
TX171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist