Provider Demographics
NPI:1306507173
Name:CAPULIN-THAYER, ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:CAPULIN-THAYER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4623
Mailing Address - Country:US
Mailing Address - Phone:623-432-8066
Mailing Address - Fax:
Practice Address - Street 1:221 N ELDEN ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4623
Practice Address - Country:US
Practice Address - Phone:623-432-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health