Provider Demographics
NPI:1437595972
Name:MOURTAJA, ANNE
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:MOURTAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-2102
Mailing Address - Country:US
Mailing Address - Phone:281-772-1892
Mailing Address - Fax:361-790-8527
Practice Address - Street 1:405 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-2717
Practice Address - Country:US
Practice Address - Phone:361-729-0633
Practice Address - Fax:361-790-8527
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty