Provider Demographics
NPI:1083871503
Name:ANIMA FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:ANIMA FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-371-6494
Mailing Address - Street 1:2475 UNIVERSITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5099
Mailing Address - Country:US
Mailing Address - Phone:920-469-1201
Mailing Address - Fax:
Practice Address - Street 1:2475 UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-5099
Practice Address - Country:US
Practice Address - Phone:920-469-1201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty