Provider Demographics
NPI:1508623984
Name:RAGAN, TANYA KISER (ALC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:KISER
Last Name:RAGAN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 GNATVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-5904
Mailing Address - Country:US
Mailing Address - Phone:256-310-9251
Mailing Address - Fax:
Practice Address - Street 1:298 GNATVILLE RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-5904
Practice Address - Country:US
Practice Address - Phone:256-310-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty