Provider Demographics
NPI:1457638868
Name:FARMAN, TANYA CANAK (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:CANAK
Last Name:FARMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:FARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:2680 E MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2828
Mailing Address - Country:US
Mailing Address - Phone:317-402-9477
Mailing Address - Fax:
Practice Address - Street 1:2680 E MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2828
Practice Address - Country:US
Practice Address - Phone:317-402-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042543A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist