Provider Demographics
NPI:1780940510
Name:ANEN, STEPHEN JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:ANEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 JACKSON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5862
Mailing Address - Country:US
Mailing Address - Phone:504-408-1170
Mailing Address - Fax:866-241-8166
Practice Address - Street 1:1539 JACKSON AVE STE 230
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5862
Practice Address - Country:US
Practice Address - Phone:504-408-1170
Practice Address - Fax:866-241-8166
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1303103TC0700X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical