Provider Demographics
NPI:1396599049
Name:WALDRUM, TAHNEE DIANNE
Entity type:Individual
Prefix:
First Name:TAHNEE
Middle Name:DIANNE
Last Name:WALDRUM
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 1:1965 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5405
Mailing Address - Country:US
Mailing Address - Phone:903-332-0257
Mailing Address - Fax:
Practice Address - Street 1:2816 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4272
Practice Address - Country:US
Practice Address - Phone:580-326-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health