Provider Demographics
NPI:1528380599
Name:CAMPBELL, TANYA DEEN
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:DEEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:DEEN
Other - Last Name:FURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 LAKIN ST.
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137
Mailing Address - Country:US
Mailing Address - Phone:970-779-8497
Mailing Address - Fax:970-563-4505
Practice Address - Street 1:285 LAKIN ST.
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137
Practice Address - Country:US
Practice Address - Phone:970-779-8497
Practice Address - Fax:970-563-4505
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPENDING101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health