Provider Demographics
NPI:1780010728
Name:STANLEY, TANYA RENAE (LLMSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENAE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW
Mailing Address - Street 1:4291 RIDGEWAY TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48632-9156
Mailing Address - Country:US
Mailing Address - Phone:231-912-0122
Mailing Address - Fax:
Practice Address - Street 1:527 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2540
Practice Address - Country:US
Practice Address - Phone:231-876-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical