Provider Demographics
NPI:1013166792
Name:MCPHERSON, TANJA R (MAE)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:R
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25088
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-1088
Mailing Address - Country:US
Mailing Address - Phone:340-713-8440
Mailing Address - Fax:
Practice Address - Street 1:2 ESTATE ORANGE GROVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-1006270-2007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor