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General NPI Number Information
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NPI Number | 1609716273
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Entity Type | Individual
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Provider Name | TINA HADEN
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Gender | Female
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 2109 E WALNUT ST STE C-120
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City | COLUMBIA
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State | MO
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Zip | 65201-6428
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 E HAMILTON CT APT A108
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City | REPUBLIC
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State | MO
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Zip | 65738-1548
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Country | US
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Telephone | 435-218-1417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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