Provider Demographics
NPI:1518457712
Name:ANSON FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:ANSON FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-439-1926
Mailing Address - Street 1:1747 HERITAGE LN STE B101
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8546
Mailing Address - Country:US
Mailing Address - Phone:385-439-1926
Mailing Address - Fax:
Practice Address - Street 1:1747 HERITAGE LN STE B101
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8546
Practice Address - Country:US
Practice Address - Phone:385-439-1926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5780998-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty