Provider Demographics
NPI:1942676655
Name:GRUBAUGH, TANYA (LCSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:GRUBAUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11344 COLOMA RD STE 250
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6300
Mailing Address - Country:US
Mailing Address - Phone:530-295-7006
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD STE 250
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-6300
Practice Address - Country:US
Practice Address - Phone:530-295-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW64783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health