Provider Demographics
NPI:1982111613
Name:ANOVA PRIVATE PRACTICE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ANOVA PRIVATE PRACTICE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-262-4387
Mailing Address - Street 1:2930 GEER RD
Mailing Address - Street 2:179
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1142
Mailing Address - Country:US
Mailing Address - Phone:209-262-4387
Mailing Address - Fax:
Practice Address - Street 1:2101 GEER RD STE 102A
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2455
Practice Address - Country:US
Practice Address - Phone:209-262-4387
Practice Address - Fax:209-262-4387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 106H00000X
CA40555251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty