Provider Demographics
NPI:1235597915
Name:STANLEY, ANNETTE (MA LPC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18185 N 83RD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0519
Mailing Address - Country:US
Mailing Address - Phone:602-633-4032
Mailing Address - Fax:
Practice Address - Street 1:18185 N 83RD AVE STE 206
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0519
Practice Address - Country:US
Practice Address - Phone:602-633-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2019-10-04
Deactivation Date:2017-12-19
Deactivation Code:
Reactivation Date:2018-03-06
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional