Healthcare Provider Details

I. General information

NPI: 1033968045
Provider Name (Legal Business Name): ANNE MARSHALL ANDERSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 N MINERSVILLE HWY
ENOCH UT
84721-7224
US

IV. Provider business mailing address

PO BOX 703
PANGUITCH UT
84759-0703
US

V. Phone/Fax

Practice location:
  • Phone: 435-267-4212
  • Fax:
Mailing address:
  • Phone: 435-616-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: