Provider Demographics
NPI:1063480572
Name:ANIS, JOYCE
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:ANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71973
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0973
Mailing Address - Country:US
Mailing Address - Phone:801-680-4211
Mailing Address - Fax:
Practice Address - Street 1:1002 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 207
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1525
Practice Address - Country:US
Practice Address - Phone:801-680-4211
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT339510-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0000740008Medicare ID - Type Unspecified