Provider Demographics
NPI:1962148924
Name:ANNIS, NANCY ALEXANDRA (LMHC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ALEXANDRA
Last Name:ANNIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:ANNIS
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:15 FAY MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879
Mailing Address - Country:US
Mailing Address - Phone:978-368-0456
Mailing Address - Fax:781-643-3792
Practice Address - Street 1:15 FAY MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879
Practice Address - Country:US
Practice Address - Phone:978-368-0456
Practice Address - Fax:781-643-3792
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALM1968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health