Basic Information
| Provider Information | |||||||||
| NPI: | 1750412102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLDING | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | BROADUS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 441 N. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ALTURAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302336312 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 441 NORTH MAIN ST | ||||||||
| Address2: | --- | ||||||||
| City: | ALTURAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961014113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302336312 | ||||||||
| FaxNumber: | 5302336339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF99575 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 123367 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.