Provider Demographics
NPI:1609193457
Name:HAND, TANYA DAWN
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DAWN
Last Name:HAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1755
Mailing Address - Country:US
Mailing Address - Phone:719-302-2703
Mailing Address - Fax:
Practice Address - Street 1:56 CLUB MANOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1679
Practice Address - Country:US
Practice Address - Phone:719-584-4671
Practice Address - Fax:719-584-4759
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health