Provider Demographics
NPI:1538960802
Name:ANDERSON, CONNOR (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 OAK HAVEN TRCE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5190
Mailing Address - Country:US
Mailing Address - Phone:615-436-3844
Mailing Address - Fax:
Practice Address - Street 1:7524 OAK HAVEN TRCE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-5190
Practice Address - Country:US
Practice Address - Phone:615-436-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health