Provider Demographics
NPI:1598122814
Name:VIDA, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:VIDA
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 1:1000 C ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-7756
Mailing Address - Country:US
Mailing Address - Phone:775-945-3387
Mailing Address - Fax:775-945-2307
Practice Address - Street 1:1000 C ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-7756
Practice Address - Country:US
Practice Address - Phone:775-945-3387
Practice Address - Fax:775-945-2307
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health