Provider Demographics
NPI:1902618598
Name:TANAKA, CIARA
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:TANAKA
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 1:8547 KING ARTHURS CT
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9485
Mailing Address - Country:US
Mailing Address - Phone:503-577-0944
Mailing Address - Fax:
Practice Address - Street 1:201 N MITCHELL ST STE 204
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1859
Practice Address - Country:US
Practice Address - Phone:231-399-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health