Provider Demographics
NPI:1154487346
Name:AANAVI, MICHAEL (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:AANAVI
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W 2ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2151
Mailing Address - Country:US
Mailing Address - Phone:907-297-8590
Mailing Address - Fax:
Practice Address - Street 1:610 W 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2151
Practice Address - Country:US
Practice Address - Phone:907-297-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16065103TC0700X
HIPSY714103TC0700X
CAAC11872171100000X
HIACU847171100000X
AK681103TC0700X
AK172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171100000XOther Service ProvidersAcupuncturist