=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194057489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA R ANKNEY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2010
-----------------------------------------------------
Last Update Date | 01/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1480 WOODSTONE DR 211
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-6869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-447-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1480 WOODSTONE DR 211
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-6869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-447-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2004008722
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------