1205136090 NPI number — ANNA MARIA GODIALI LPC

Table of content: ANNA MARIA GODIALI LPC (NPI 1205136090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205136090 NPI number — ANNA MARIA GODIALI LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODIALI
Provider First Name:
ANNA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COUNSELING
Provider Other First Name:
ADVANTAGE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205136090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HILLCREST COUNSELING LLC
Provider Second Line Business Mailing Address:
15110 BENDING BRAE COURT
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53005-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-244-9350
Provider Business Mailing Address Fax Number:
989-893-3528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HILLCREST COUNSELING LLC
Provider Second Line Business Practice Location Address:
15110 BENDING BRAE COURT
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-244-9350
Provider Business Practice Location Address Fax Number:
989-893-3528
Provider Enumeration Date:
10/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401008740 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 7707-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)