Provider Demographics
NPI:1770904617
Name:HILL, TANYELL LEEJEAN
Entity type:Individual
Prefix:
First Name:TANYELL
Middle Name:LEEJEAN
Last Name:HILL
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 1:608 NE KATHERINE PL APT 87
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-4100
Mailing Address - Country:US
Mailing Address - Phone:405-370-9908
Mailing Address - Fax:
Practice Address - Street 1:608 NE KATHERINE PL APT 87
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-4100
Practice Address - Country:US
Practice Address - Phone:405-370-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst