Provider Demographics
NPI:1639693831
Name:AKATOR, ANTHONY KAFUI (MCJ)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:KAFUI
Last Name:AKATOR
Suffix:
Gender:M
Credentials:MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 N ROSE WATER PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2604
Mailing Address - Country:US
Mailing Address - Phone:520-304-6709
Mailing Address - Fax:
Practice Address - Street 1:4131 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1941
Practice Address - Country:US
Practice Address - Phone:520-207-9716
Practice Address - Fax:520-844-6695
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09170106E00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst