Provider Demographics
NPI:1326262650
Name:AXFORD, ANE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANE
Middle Name:
Last Name:AXFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:SPENCERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12165-0006
Mailing Address - Country:US
Mailing Address - Phone:385-288-9399
Mailing Address - Fax:
Practice Address - Street 1:825 ROUTE 203
Practice Address - Street 2:
Practice Address - City:SPENCERTOWN
Practice Address - State:NY
Practice Address - Zip Code:12165
Practice Address - Country:US
Practice Address - Phone:385-288-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000761106H00000X
UT9002274-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist