Healthcare Provider Details

I. General information

NPI: 1598969800
Provider Name (Legal Business Name): TANYA L MAGNESS LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA L COPPENBARGER LPC, LADC

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E WOLF ST
MADILL OK
73446
US

IV. Provider business mailing address

300 E WOLF ST
MADILL OK
73446
US

V. Phone/Fax

Practice location:
  • Phone: 580-730-0168
  • Fax: 580-872-4661
Mailing address:
  • Phone: 580-730-0168
  • Fax: 580-872-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number845
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3695
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: