Provider Demographics
NPI:1508654336
Name:BURGESS, TANYA LASHEA (LMSW)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LASHEA
Last Name:BURGESS
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N 3RD AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1549
Mailing Address - Country:US
Mailing Address - Phone:602-820-4418
Mailing Address - Fax:
Practice Address - Street 1:1904 W PARKSIDE LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1232
Practice Address - Country:US
Practice Address - Phone:602-820-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker