Provider Demographics
NPI:1730486515
Name:PELLANT, TANYA SUE (LSW, CSW-INTERN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:PELLANT
Suffix:
Gender:F
Credentials:LSW, CSW-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 KARIN DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2628
Mailing Address - Country:US
Mailing Address - Phone:775-722-8839
Mailing Address - Fax:
Practice Address - Street 1:844 W NYE LN STE 201
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1570
Practice Address - Country:US
Practice Address - Phone:775-885-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8809-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical