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General NPI Number Information
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NPI Number | 1396532289
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Entity Type | Organization
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Legal Business Name | TANGERINE THERAPY
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 210 N WELLS ST APT 3107
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City | CHICAGO
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State | IL
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Zip | 60606-1345
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Country | US
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Telephone | 916-430-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 6022 W WHISTLE STOP RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-1467
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Country | US
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Telephone | 916-430-2981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA CLAVELL
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Credential | LMFT
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Telephone | 916-430-2981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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