Provider Demographics
NPI:1770188096
Name:ANDERSON, TIANA MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TIANA
Other - Middle Name:MARIE
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5094
Mailing Address - Country:US
Mailing Address - Phone:512-553-6204
Mailing Address - Fax:
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5094
Practice Address - Country:US
Practice Address - Phone:512-553-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical