MEDICARE: MS. TANYA M MARK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2010037457	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548561046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA M MARK LPC

Provider Business Mailing Address
First Line	:	6732 CREST AVE
Second Line	:	1ST FLOOR
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2506
Country	:	US
Telephone Number	:	314-704-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	9666 OLIVE BLVD
Second Line	:	SUITE 400
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3013
Country	:	US
Telephone Number	:	314-785-7274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	12/30/2014

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