Provider Demographics
NPI:1669856977
Name:THOMAS, TANYA (MA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 GUNDERSEN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2403
Mailing Address - Country:US
Mailing Address - Phone:630-871-2100
Mailing Address - Fax:630-588-0824
Practice Address - Street 1:336 GUNDERSEN DR
Practice Address - Street 2:SUITE B
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2403
Practice Address - Country:US
Practice Address - Phone:630-871-2100
Practice Address - Fax:630-588-0824
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health