Provider Demographics
NPI:1245891019
Name:LESANE, TANYA LATRELL (LCMH)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LATRELL
Last Name:LESANE
Suffix:
Gender:F
Credentials:LCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 SAWTOOTH CT
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5125
Mailing Address - Country:US
Mailing Address - Phone:803-316-2885
Mailing Address - Fax:
Practice Address - Street 1:9924B W. JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS0MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-968-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60884547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health