Provider Demographics
NPI:1972685642
Name:UNRAST, ANN MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:UNRAST
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-1091
Mailing Address - Fax:520-682-4132
Practice Address - Street 1:13395 N MARANA MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-682-1091
Practice Address - Fax:520-682-4132
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0096681101YP2500X
AZLPC-16477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-16477Medicaid
NM18677037Medicaid
NM12437531Medicaid