Provider Demographics
NPI:1619107570
Name:TAVE-SANDERS, GRETA (LBSW)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:TAVE-SANDERS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7328 MANASSAS LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7322
Mailing Address - Country:US
Mailing Address - Phone:903-525-9633
Mailing Address - Fax:
Practice Address - Street 1:7328 MANASSAS LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7322
Practice Address - Country:US
Practice Address - Phone:903-525-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26928171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26928OtherLBSW