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General NPI Number Information
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NPI Number | 1982317905
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Entity Type | Individual
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Provider Name | SANTANNA TAVE LPC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 13172 STATE HIGHWAY 64 E
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City | TYLER
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State | TX
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Zip | 75707-5340
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Country | US
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Telephone | 903-535-9041
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Fax | 903-630-6740
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Provider Business Mailing Address
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Address Line | 212 ASH DR
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City | BULLARD
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State | TX
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Zip | 75757-5052
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Country | US
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Telephone | 903-824-1614
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 84972
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License Number State | TX
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