Provider Demographics
NPI:1982223764
Name:FREEDLAND, TANYA AYN (MPS, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:AYN
Last Name:FREEDLAND
Suffix:
Gender:F
Credentials:MPS, LPCC, LADC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:AYN
Other - Last Name:LINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2033
Mailing Address - Country:US
Mailing Address - Phone:651-243-0619
Mailing Address - Fax:
Practice Address - Street 1:1309 TIMBER LN
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2033
Practice Address - Country:US
Practice Address - Phone:612-616-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303700101YA0400X
MN3407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty