Provider Demographics
NPI:1134575814
Name:KORT, TANYA LEIMOMI (LICENSED PSYCHOLOGIS)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LEIMOMI
Last Name:KORT
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 NORCIA LOOP
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642
Mailing Address - Country:US
Mailing Address - Phone:352-505-6363
Mailing Address - Fax:352-505-6383
Practice Address - Street 1:250 NW 76TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6668
Practice Address - Country:US
Practice Address - Phone:352-505-6363
Practice Address - Fax:352-505-6383
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8054103T00000X
TX38133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist