Active NPI
Charles Mark Anderson, PH.D
- Clinical Psychologist
- Gig Harbor, WA
National Provider Identifier
1679711436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY00001052
- Practice address
- 2421 71St Avenue CT NW
Gig Harbor, WA 98335-6451 - Phone
- (253) 549-3822
- NPI assigned
- Jan 31, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY00001052 | WA | Primary |
Addresses
Primary practice location
2421 71St Avenue CT NW
Gig Harbor, WA 98335-6451
Mailing address
2421 71St Avenue CT NW
Gig Harbor, WA 98335-6451
Phone (253) 549-3822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY00001052 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233360000000",
"number": "1679711436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2421 71ST AVENUE CT NW",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983356451",
"telephone_number": "253-549-3822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2421 71ST AVENUE CT NW",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983356451",
"telephone_number": "253-549-3822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "CHARLES",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-31",
"last_updated": "2009-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PSY00001052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gig Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.