Provider Demographics
NPI:1689892515
Name:PROBST, ANNETTE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:PROBST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 S DANIELS RD
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3864
Mailing Address - Country:US
Mailing Address - Phone:435-654-3181
Mailing Address - Fax:435-654-3299
Practice Address - Street 1:1375 S DANIELS RD
Practice Address - Street 2:SUITE # 2
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3864
Practice Address - Country:US
Practice Address - Phone:435-654-3181
Practice Address - Fax:435-654-3299
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27850756004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional