MEDICARE: NANCY ANN DOWNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC-11616	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	869406	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1194796318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN DOWNS

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-0579
Country	:	US
Telephone Number	:	928-337-4301
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 W CLEVELAND AVE
Second Line	:
City	:	ST. JOHNS
State	:	AZ
Zip	:	85936
Country	:	US
Telephone Number	:	928-337-4301
Fax Number	:	928-337-2269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/08/2007

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