Provider Demographics
NPI:1912928821
Name:CALVERT, ANITA JUNE (DRPH, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:JUNE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:DRPH, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 AVENUE H STE 101
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5759
Mailing Address - Country:US
Mailing Address - Phone:830-693-4109
Mailing Address - Fax:830-693-6790
Practice Address - Street 1:110 AVENUE H STE 101
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5759
Practice Address - Country:US
Practice Address - Phone:830-693-4109
Practice Address - Fax:830-693-6790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX819101YP2500X
TXS021021041C0700X
TX9001355-0019264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10013482OtherA. CALVERT - AMERIGROUP
TX0S69UMedicare ID - Type UnspecifiedANITA CALVERT