Healthcare Provider Details

I. General information

NPI: 1811229552
Provider Name (Legal Business Name): TANYA L WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA HANKS LCSW

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 N 100 E
SPRINGVILLE UT
84663-3177
US

IV. Provider business mailing address

1659 N 100 E
SPRINGVILLE UT
84663-3177
US

V. Phone/Fax

Practice location:
  • Phone: 480-553-1843
  • Fax:
Mailing address:
  • Phone: 480-553-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW32507
License Number StateID

VII. Legacy identifiers

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

# 1
Identifier1811229552
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: