Provider Demographics
NPI:1720454523
Name:NOVAK, TIANNA
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:NOVAK
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:PO BOX 822
Mailing Address - Street 2:1658 KETTEN RD
Mailing Address - City:TONOPAH
Mailing Address - State:NV
Mailing Address - Zip Code:89049-0822
Mailing Address - Country:US
Mailing Address - Phone:913-702-4309
Mailing Address - Fax:
Practice Address - Street 1:601 EAST ST
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5368
Practice Address - Country:US
Practice Address - Phone:702-913-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor