Provider Demographics
NPI:1891316576
Name:WOODBERRY, TANYIKA (LPC)
Entity Type:Individual
Prefix:
First Name:TANYIKA
Middle Name:
Last Name:WOODBERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 100A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9145
Mailing Address - Country:US
Mailing Address - Phone:254-501-3745
Mailing Address - Fax:254-501-3608
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 100A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9145
Practice Address - Country:US
Practice Address - Phone:254-501-3745
Practice Address - Fax:254-501-3608
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional