=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801219738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANYA NYSON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2014
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 BOARDMAN AVE
-----------------------------------------------------
City | TRAVERSE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49684-2687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-304-3354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1022 E STATE ST
-----------------------------------------------------
City | TRAVERSE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49686-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-304-3354
-----------------------------------------------------
Fax | 616-304-3354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOTHERAPIST
-----------------------------------------------------
Name | ANYA F NYSON
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 616-304-3354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801090188
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------