Provider Demographics
NPI:1669908877
Name:FEGAN, TARNYA (LCMHC, MLADC)
Entity type:Individual
Prefix:
First Name:TARNYA
Middle Name:
Last Name:FEGAN
Suffix:
Gender:F
Credentials:LCMHC, MLADC
Other - Prefix:
Other - First Name:TARNYA
Other - Middle Name:
Other - Last Name:MILLER FEGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC, MLADC
Mailing Address - Street 1:12 LADYSLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-2205
Mailing Address - Country:US
Mailing Address - Phone:603-498-6452
Mailing Address - Fax:
Practice Address - Street 1:2456 LAFAYETTE RD
Practice Address - Street 2:SUITE 12
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5624
Practice Address - Country:US
Practice Address - Phone:603-498-6452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0994101YA0400X
NH1127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)