Provider Demographics
NPI:1982878245
Name:NANEIX, ROBIN P (MA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:P
Last Name:NANEIX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150173
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0173
Mailing Address - Country:US
Mailing Address - Phone:801-479-0601
Mailing Address - Fax:801-476-8885
Practice Address - Street 1:917 COUNTRY HILLS DR
Practice Address - Street 2:#5
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2535
Practice Address - Country:US
Practice Address - Phone:801-334-9785
Practice Address - Fax:801-334-9786
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5989687-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional