Provider Demographics
NPI:1952512345
Name:HOAGLAND, TANNA L (MFT)
Entity Type:Individual
Prefix:
First Name:TANNA
Middle Name:L
Last Name:HOAGLAND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 AVIATION BLVD
Mailing Address - Street 2:STE. 103
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4002
Mailing Address - Country:US
Mailing Address - Phone:310-372-4245
Mailing Address - Fax:
Practice Address - Street 1:1426 AVIATION BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4002
Practice Address - Country:US
Practice Address - Phone:310-372-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist