Healthcare Provider Details

I. General information

NPI: 1457638868
Provider Name (Legal Business Name): TANYA CANAK FARMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA FARMAN PH.D., HSPP

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E MAIN ST STE 205
PLAINFIELD IN
46168-2828
US

IV. Provider business mailing address

2680 E MAIN ST STE 205
PLAINFIELD IN
46168-2828
US

V. Phone/Fax

Practice location:
  • Phone: 317-402-9477
  • Fax:
Mailing address:
  • Phone: 317-402-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042543A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: