Provider Demographics
NPI:1104014356
Name:TENNANT, JOY ELAINE (MA)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ELAINE
Last Name:TENNANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:ELAINE
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-529-9454
Mailing Address - Fax:530-529-9456
Practice Address - Street 1:590 ANTELOPE BLVD STE 40A
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2477
Practice Address - Country:US
Practice Address - Phone:530-529-9454
Practice Address - Fax:530-529-9456
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104014356OtherNPI