Provider Demographics
NPI:1285105726
Name:MARQUES, ANA B
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:B
Last Name:MARQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:MARQUES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:11075 S STATE ST STE 13
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5193
Mailing Address - Country:US
Mailing Address - Phone:801-948-0939
Mailing Address - Fax:801-931-2320
Practice Address - Street 1:11075 S STATE ST STE 13
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5193
Practice Address - Country:US
Practice Address - Phone:801-948-0939
Practice Address - Fax:801-931-2320
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11605053-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11605053-3902OtherSTATE LICENSE