Provider Demographics
NPI:1760867279
Name:TANIS, JENNY CLAIRE (MA)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:CLAIRE
Last Name:TANIS
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 1:1201 BRICKYARD WAY
Mailing Address - Street 2:APT #405
Mailing Address - City:POINT RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-4139
Mailing Address - Country:US
Mailing Address - Phone:201-788-5031
Mailing Address - Fax:
Practice Address - Street 1:1701 OCEAN AVE
Practice Address - Street 2:OMI FAMILY CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1727
Practice Address - Country:US
Practice Address - Phone:415-452-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-26
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program