Provider Demographics
NPI:1356012942
Name:ANSAY, EMILIE MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:MARIE
Last Name:ANSAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4971 BONITA BAY BLVD UNIT 2205
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1765
Mailing Address - Country:US
Mailing Address - Phone:414-534-3114
Mailing Address - Fax:
Practice Address - Street 1:4971 BONITA BAY BLVD UNIT 2205
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1765
Practice Address - Country:US
Practice Address - Phone:414-534-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health