Provider Demographics
NPI:1346889052
Name:EUBANKS, TANYA LYNNE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYNNE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9141 30TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2301
Mailing Address - Country:US
Mailing Address - Phone:612-607-9794
Mailing Address - Fax:
Practice Address - Street 1:9141 30TH AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2301
Practice Address - Country:US
Practice Address - Phone:612-607-9794
Practice Address - Fax:763-951-2335
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health