Healthcare Provider Details

I. General information

NPI: 1255495230
Provider Name (Legal Business Name): ANITA M. PLANN MPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 STATE ROUTE 37
AKWESASNE NY
13655-3109
US

IV. Provider business mailing address

30 CENTER ST
MALONE NY
12953-2021
US

V. Phone/Fax

Practice location:
  • Phone: 518-358-3141
  • Fax:
Mailing address:
  • Phone: 518-483-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number932
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number999
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: