=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629524939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA WARDNER LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2016
-----------------------------------------------------
Last Update Date | 10/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4676 LAKEVIEW AVE STE 109E
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92886-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-222-7049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 E ADDINGTON DR
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92807-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-222-7049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 103825
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------