Provider Demographics
NPI:1902201544
Name:NATHE, TANA J
Entity Type:Individual
Prefix:MS
First Name:TANA
Middle Name:J
Last Name:NATHE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANA
Other - Middle Name:J
Other - Last Name:NATHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:915 WAUKAZOO AVE.
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-838-1403
Mailing Address - Fax:
Practice Address - Street 1:915 WAUKAZOO AVE.
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-838-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional