Provider Demographics
NPI:1639247000
Name:PROTSENKO, TANIA (MA IN COUNSELING PSY)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:PROTSENKO
Suffix:
Gender:F
Credentials:MA IN COUNSELING PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 TRADEWINDS DR 206
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-893-6668
Mailing Address - Fax:
Practice Address - Street 1:295 TRADEWINDS DR APT 206
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6078
Practice Address - Country:US
Practice Address - Phone:408-893-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAMFT # 44132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist