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NPI Code Detail

MEDICARE: MARY ANNE ANDERSON CMHC

MEDICARE: MARY ANNE ANDERSON CMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor8360609-6009UT
2101YM0800XMental Health Counselor8360609-6004UT

General Provider Information

NPI Number : 1063804219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANNE ANDERSON CMHC
Provider Business Mailing Address
First Line : 4465 S 900 E STE 150
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-3944
Country : US
Telephone Number : 435-248-2089
Fax Number : 801-207-5104
Provider Business Practice Location Address
First Line : 4465 S 900 E STE 150
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-3944
Country : US
Telephone Number : 435-248-2089
Fax Number : 801-207-5104
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2015
Last Update Date : 05/03/2019

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Directions to “ MARY ANNE ANDERSON CMHC” Practice Location

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