Provider Demographics
NPI:1508575275
Name:GHAZZARA, TANIA STEPHANIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:STEPHANIE
Last Name:GHAZZARA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 LOWE RD UNIT 5209
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8739
Mailing Address - Country:US
Mailing Address - Phone:305-215-7285
Mailing Address - Fax:
Practice Address - Street 1:2601 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8942
Practice Address - Country:US
Practice Address - Phone:956-291-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-2027-0103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical