Provider Demographics
NPI:1619105582
Name:ANCEVIC, ANN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:ANCEVIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE C #261
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-1528
Mailing Address - Country:US
Mailing Address - Phone:719-266-3445
Mailing Address - Fax:
Practice Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:SUITE C #261
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1528
Practice Address - Country:US
Practice Address - Phone:719-266-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY3783103TC0700X
FLPY7756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical