Healthcare Provider Details

I. General information

NPI: 1104253491
Provider Name (Legal Business Name): KATHRYN M TANSLEY MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N MAIN ST STE 2
SOUTHINGTON CT
06489-2555
US

IV. Provider business mailing address

163 ANNELISE AVE
SOUTHINGTON CT
06489-1826
US

V. Phone/Fax

Practice location:
  • Phone: 860-620-7748
  • Fax:
Mailing address:
  • Phone: 860-620-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003538
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: