Provider Demographics
NPI:1336394790
Name:MAYEDA, TANI
Entity Type:Individual
Prefix:
First Name:TANI
Middle Name:
Last Name:MAYEDA
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 1:407 COVEY AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-4283
Mailing Address - Country:US
Mailing Address - Phone:661-477-8260
Mailing Address - Fax:
Practice Address - Street 1:2901 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5602
Practice Address - Country:US
Practice Address - Phone:661-398-4303
Practice Address - Fax:661-398-4306
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)