Provider Demographics
NPI:1164285672
Name:KADIS, ANNA NICOLE (LLMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NICOLE
Last Name:KADIS
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 MENTOR AVE APT C4
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5655
Mailing Address - Country:US
Mailing Address - Phone:937-367-1232
Mailing Address - Fax:
Practice Address - Street 1:7950 MENTOR AVE APT C4
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5655
Practice Address - Country:US
Practice Address - Phone:937-367-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist