Provider Demographics
NPI:1114096724
Name:HUNNIUTT, ANTHONY WARREN (LSW LAOC LICENSED SO)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WARREN
Last Name:HUNNIUTT
Suffix:
Gender:M
Credentials:LSW LAOC LICENSED SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 121ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448
Mailing Address - Country:US
Mailing Address - Phone:763-754-6696
Mailing Address - Fax:
Practice Address - Street 1:7590 LYRIC LANE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-236-4509
Practice Address - Fax:763-236-4370
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301004101YA0400X
MN12707104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker