Provider Demographics
NPI:1891904355
Name:EAGLETON, ANITA LEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LEE
Last Name:EAGLETON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:L
Other - Last Name:BURKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:50 QUISISANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1522
Mailing Address - Country:US
Mailing Address - Phone:415-454-5955
Mailing Address - Fax:415-454-3241
Practice Address - Street 1:50 QUISISANA DRIVE
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1522
Practice Address - Country:US
Practice Address - Phone:415-454-5955
Practice Address - Fax:415-454-3241
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist