Provider Demographics
NPI:1184981219
Name:CORRAL, TANNA M (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TANNA
Middle Name:M
Last Name:CORRAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 CANDELARIA RD NE
Mailing Address - Street 2:PO BOX 37440
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1907
Mailing Address - Country:US
Mailing Address - Phone:505-889-3412
Mailing Address - Fax:505-889-3422
Practice Address - Street 1:512 NORTH ROSS
Practice Address - Street 2:
Practice Address - City:MOUNTAINAIR
Practice Address - State:NM
Practice Address - Zip Code:87036
Practice Address - Country:US
Practice Address - Phone:505-847-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-057571041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool