Healthcare Provider Details

I. General information

NPI: 1649469123
Provider Name (Legal Business Name): TANYA GALANES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 S CICERO AVE SUITE 208
OAK LAWN IL
60453-5400
US

IV. Provider business mailing address

10735 S CICERO AVE SUITE 208
OAK LAWN IL
60453-5400
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0001
  • Fax: 708-424-1394
Mailing address:
  • Phone: 708-424-0001
  • Fax: 708-424-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: