Healthcare Provider Details

I. General information

NPI: 1376487330
Provider Name (Legal Business Name): TANESA HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 SE 701 RD
COLLINS MO
64738-7129
US

IV. Provider business mailing address

3915 LLOYD ST
KANSAS CITY KS
66103-2828
US

V. Phone/Fax

Practice location:
  • Phone: 620-423-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009123
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001882
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYPACTAPIT1735160
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2025051188
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: