Provider Demographics
NPI:1073681359
Name:LANDERS, ANN (MFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7604
Mailing Address - Country:US
Mailing Address - Phone:760-580-7708
Mailing Address - Fax:760-726-8700
Practice Address - Street 1:550 W VISTA WAY
Practice Address - Street 2:307
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5732
Practice Address - Country:US
Practice Address - Phone:760-580-7708
Practice Address - Fax:760-726-2292
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health