Healthcare Provider Details

I. General information

NPI: 1760952030
Provider Name (Legal Business Name): TANARY CERROS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 COFFEE RD STE A1
MODESTO CA
95355-1756
US

IV. Provider business mailing address

PO BOX 3507
MODESTO CA
95352-3507
US

V. Phone/Fax

Practice location:
  • Phone: 209-867-2476
  • Fax: 209-553-7291
Mailing address:
  • Phone: 209-867-2476
  • Fax: 209-553-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT164364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: