Provider Demographics
NPI:1285372383
Name:ANNON, JAMES
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:ANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6B VISTA POINT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-5992
Mailing Address - Country:US
Mailing Address - Phone:505-660-2890
Mailing Address - Fax:
Practice Address - Street 1:6B VISTA POINT RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-5992
Practice Address - Country:US
Practice Address - Phone:505-660-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTB-2022-0026101Y00000X
NMCTB-2022-0026101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor