Provider Demographics
NPI:1609367564
Name:GLOVER, TANYA M (LMHC-A)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12325 TANAGER LN NW APT 104
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8188
Mailing Address - Country:US
Mailing Address - Phone:316-993-6322
Mailing Address - Fax:
Practice Address - Street 1:12325 TANAGER LN NW APT 104
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8188
Practice Address - Country:US
Practice Address - Phone:316-993-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60712799101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor