Healthcare Provider Details

I. General information

NPI: 1558289330
Provider Name (Legal Business Name): ANNA BEATRICE CARMICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 COFFMAN ST
LONGMONT CO
80501-5450
US

IV. Provider business mailing address

529 COFFMAN ST
LONGMONT CO
80501-5450
US

V. Phone/Fax

Practice location:
  • Phone: 315-406-4108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: