Provider Demographics
NPI:1245514876
Name:THOMAS, TANYA N
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:N
Last Name:THOMAS
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 1:12719 E 40TH ST APT 812
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3515
Mailing Address - Country:US
Mailing Address - Phone:918-955-9821
Mailing Address - Fax:
Practice Address - Street 1:324 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2532
Practice Address - Country:US
Practice Address - Phone:918-279-6565
Practice Address - Fax:918-279-6551
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health