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General NPI Number Information
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NPI Number | 1720586761
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Entity Type | Organization
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Legal Business Name | ANESIS CENTER FOR MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 815 FORWARD DR.
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City | MADISON
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State | WI
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Zip | 53711
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Country | US
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Telephone | 608-268-6530
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Fax | 608-709-1744
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Provider Business Mailing Address
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Address Line | 815 FORWARD DR.
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City | MADISON
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State | WI
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Zip | 53711
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Country | US
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Telephone | 608-268-6530
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Fax | 608-709-1744
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Authorized Official
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Title or Position | OWNER, SERVICE DIRECTOR
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Name | MYRA MCNAIR
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Credential | LMFT
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Telephone | 608-268-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | WI
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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