Healthcare Provider Details

I. General information

NPI: 1154487346
Provider Name (Legal Business Name): MICHAEL AANAVI PHD, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 2ND AVE STE 100
ANCHORAGE AK
99501-2151
US

IV. Provider business mailing address

610 W 2ND AVE STE 100
ANCHORAGE AK
99501-2151
US

V. Phone/Fax

Practice location:
  • Phone: 907-297-8590
  • Fax:
Mailing address:
  • Phone: 907-297-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16065
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY714
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11872
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU847
License Number StateHI
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number681
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number172
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: