Provider Demographics
NPI:1710551114
Name:HOORNAERT, TANA RAE (LAPC)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:RAE
Last Name:HOORNAERT
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:RAE
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5726
Mailing Address - Country:US
Mailing Address - Phone:701-258-3780
Mailing Address - Fax:701-751-1328
Practice Address - Street 1:600 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5726
Practice Address - Country:US
Practice Address - Phone:701-258-3780
Practice Address - Fax:701-751-1328
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1124-5-15-21A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health