Provider Demographics
NPI:1639644107
Name:ANOMALAY, JOSEPH (LCPC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ANOMALAY
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E FAIRVIEW AVE # 217
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1733
Mailing Address - Country:US
Mailing Address - Phone:651-428-0274
Mailing Address - Fax:
Practice Address - Street 1:6126 W STATE ST STE 307
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-2741
Practice Address - Country:US
Practice Address - Phone:651-428-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7328101YM0800X
IDLPC-6455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health