Provider Demographics
NPI:1720654841
Name:VON KONSKY, ANIETT
Entity type:Individual
Prefix:
First Name:ANIETT
Middle Name:
Last Name:VON KONSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANIETT
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17164 W WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1718
Mailing Address - Country:US
Mailing Address - Phone:623-330-6820
Mailing Address - Fax:
Practice Address - Street 1:4619 W SAGUARO DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-4424
Practice Address - Country:US
Practice Address - Phone:602-218-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19952101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor