Provider Demographics
NPI:1245089903
Name:BOTTER, ANNE TANKERSLEY (MA, CMHC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:TANKERSLEY
Last Name:BOTTER
Suffix:
Gender:F
Credentials:MA, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 MANLEY WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7136
Mailing Address - Country:US
Mailing Address - Phone:512-576-7760
Mailing Address - Fax:
Practice Address - Street 1:1318 MANLEY WAY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7136
Practice Address - Country:US
Practice Address - Phone:512-576-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health