Provider Demographics
NPI:1760962195
Name:ANDERSON, TONYA D (QMHA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 ARIEL DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2258
Mailing Address - Country:US
Mailing Address - Phone:775-232-0807
Mailing Address - Fax:
Practice Address - Street 1:4600 KIETZKE LN STE O260
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5046
Practice Address - Country:US
Practice Address - Phone:702-319-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation