Provider Demographics
NPI:1871621060
Name:ANDERSON, CLINTON THOMAS (LMFT)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:THOMAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 FLORENCE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7904
Mailing Address - Country:US
Mailing Address - Phone:254-462-2775
Mailing Address - Fax:254-630-1115
Practice Address - Street 1:1519 FLORENCE RD STE 5
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7904
Practice Address - Country:US
Practice Address - Phone:254-462-2775
Practice Address - Fax:254-630-1115
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291812001Medicaid