Provider Demographics
NPI:1760555676
Name:POELLER, TANYA (MS)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:POELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3797
Mailing Address - Country:US
Mailing Address - Phone:702-486-7451
Mailing Address - Fax:702-486-5029
Practice Address - Street 1:333 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3797
Practice Address - Country:US
Practice Address - Phone:702-486-7451
Practice Address - Fax:702-486-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health