Provider Demographics
NPI:1538405436
Name:ANDERSEN, ALEXANDER K (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:K
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4253
Mailing Address - Country:US
Mailing Address - Phone:480-528-1048
Mailing Address - Fax:
Practice Address - Street 1:107 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3123
Practice Address - Country:US
Practice Address - Phone:480-528-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional