Provider Demographics
NPI:1558366559
Name:TANIS, PAULA R (LPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:TANIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E. GUADALUPE RD. #109
Mailing Address - Street 2:KIRSTEN SORENSEN
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-505-4475
Mailing Address - Fax:480-505-4252
Practice Address - Street 1:6301 S. MCCLINTOCK DR. #215
Practice Address - Street 2:KIRSTEN SORENSEN
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:480-820-6657
Practice Address - Fax:480-730-0803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLPC10831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ916215Medicaid