Provider Demographics
NPI:1407298268
Name:THEDFORD, ANNA DANAE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:DANAE
Last Name:THEDFORD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 SE DIVISION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1250
Mailing Address - Country:US
Mailing Address - Phone:541-229-8861
Mailing Address - Fax:
Practice Address - Street 1:1180 SE DIVISION ST STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1250
Practice Address - Country:US
Practice Address - Phone:541-229-8861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500677784Medicaid