Provider Demographics
NPI:1568006344
Name:BAILEY, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:BOROUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:404 N AMA FILLE CIR
Mailing Address - Street 2:
Mailing Address - City:ELK RIDGE
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4526
Mailing Address - Country:US
Mailing Address - Phone:801-234-9999
Mailing Address - Fax:
Practice Address - Street 1:404 N AMA FILLE CIR
Practice Address - Street 2:
Practice Address - City:ELK RIDGE
Practice Address - State:UT
Practice Address - Zip Code:84651-4526
Practice Address - Country:US
Practice Address - Phone:801-234-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5505213-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical