Provider Demographics
NPI:1144407248
Name:ANTHONY, LOIS LUCILLE
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:LUCILLE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:951 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3538
Mailing Address - Country:US
Mailing Address - Phone:970-241-2326
Mailing Address - Fax:970-248-9006
Practice Address - Street 1:951 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3538
Practice Address - Country:US
Practice Address - Phone:970-241-2326
Practice Address - Fax:970-248-9006
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7537104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical