Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 60890986 | WA |
Y | 103T00000X | Psychologist | 60890986 | WA |
NPI | 1013349216 |
---|---|
Provider Name | Dr. Tanya Simone Crabb |
First Address | Ridgecrest, CA 93555-2703 |
Second Address | Kailua, HI 96734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 04/02/2019 |