Provider Demographics
NPI:1396532289
Name:TANGERINE THERAPY
Entity type:Organization
Organization Name:TANGERINE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-430-2981
Mailing Address - Street 1:6022 W WHISTLE STOP RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1467
Mailing Address - Country:US
Mailing Address - Phone:916-430-2981
Mailing Address - Fax:
Practice Address - Street 1:210 N WELLS ST APT 3107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1345
Practice Address - Country:US
Practice Address - Phone:916-430-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty