Provider Demographics
NPI:1972195477
Name:SIDLE, AYANNA TAMASHA
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:TAMASHA
Last Name:SIDLE
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 1:2601 WOODLAND PARK DR APT 1204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6163
Mailing Address - Country:US
Mailing Address - Phone:832-671-3362
Mailing Address - Fax:
Practice Address - Street 1:2601 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6161
Practice Address - Country:US
Practice Address - Phone:832-671-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor