Provider Demographics
NPI:1740760115
Name:KIERNAN, TANYA ANNETTE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:ANNETTE
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9001
Mailing Address - Country:US
Mailing Address - Phone:209-754-2300
Mailing Address - Fax:209-754-2215
Practice Address - Street 1:3412 DOUBLE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9275
Practice Address - Country:US
Practice Address - Phone:209-754-2300
Practice Address - Fax:209-754-2215
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty