Provider Demographics
NPI:1043288012
Name:SUDDRETH, ANNE-MARIE G (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ANNE-MARIE
Middle Name:G
Last Name:SUDDRETH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 RIVA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6300
Mailing Address - Country:US
Mailing Address - Phone:828-773-3659
Mailing Address - Fax:
Practice Address - Street 1:3507 RIVA RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6300
Practice Address - Country:US
Practice Address - Phone:970-355-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107399Medicaid