Provider Demographics
NPI:1952674087
Name:WEIGAND, TANYA WYONNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:WYONNE
Last Name:WEIGAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2403 CORONA RD
Mailing Address - Street 2:AFFINITY COUNSELING LLC
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6765
Mailing Address - Country:US
Mailing Address - Phone:573-808-4026
Mailing Address - Fax:573-446-0554
Practice Address - Street 1:2403 CORONA RD
Practice Address - Street 2:AFFINITY COUNSELING LLC
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6765
Practice Address - Country:US
Practice Address - Phone:573-808-4026
Practice Address - Fax:573-446-0554
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011010752104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker