Provider Demographics
NPI:1891476289
Name:THEIN, TONYA TANNIAL
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:TANNIAL
Last Name:THEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4465
Mailing Address - Country:US
Mailing Address - Phone:707-971-6265
Mailing Address - Fax:
Practice Address - Street 1:429 SPEERS RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3123
Practice Address - Country:US
Practice Address - Phone:707-909-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)