Provider Demographics
NPI:1598404816
Name:ANCHORTHERAPY LLC
Entity Type:Organization
Organization Name:ANCHORTHERAPY LLC
Other - Org Name:ANCHOR THERAPY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:605-641-0566
Mailing Address - Street 1:6232 BANKERS RD LOWR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9747
Mailing Address - Country:US
Mailing Address - Phone:605-641-0566
Mailing Address - Fax:
Practice Address - Street 1:6232 BANKERS RD LOWER
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9747
Practice Address - Country:US
Practice Address - Phone:605-641-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14070741OtherCAQH