Provider Demographics
NPI:1881476760
Name:ANHOLT, MERYNN BETTY
Entity type:Individual
Prefix:
First Name:MERYNN
Middle Name:BETTY
Last Name:ANHOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2552
Mailing Address - Country:US
Mailing Address - Phone:385-498-9944
Mailing Address - Fax:
Practice Address - Street 1:333 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2552
Practice Address - Country:US
Practice Address - Phone:385-498-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician