Provider Demographics
NPI:1124190061
Name:TANSLEY, DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:TANSLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:88 MDOS-SGOHC
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5546
Mailing Address - Country:US
Mailing Address - Phone:937-257-1296
Mailing Address - Fax:937-656-1192
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:88 MDOS-SGOHC
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5546
Practice Address - Country:US
Practice Address - Phone:937-257-1296
Practice Address - Fax:937-656-1192
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1425OtherPSYCHOLIOGIST LICENSE #