Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | AZ | |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | AZ | |
N | 103TA0700X | Adult Development & Aging Psychologist | AZ | |
N | 103TB0200X | Cognitive & Behavioral Psychologist | AZ | |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | AZ | |
N | 103TF0000X | Family Psychologist | AZ | |
N | 103TH0100X | Health Service | AZ | |
N | 103TM1800X | Intellectual & Developmental Disabilities | AZ | |
N | 103TR0400X | Rehabilitation Psychologist | AZ | |
N | 104100000X | Social Worker | AZ |
NPI | 1194497719 |
---|---|
Provider Name | Tanaea Evette Wright |
First Address | El Mirage, AZ 85335-4217 |
Second Address | El Mirage, AZ 85335-4217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2021 |
Last Update Date | 01/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
843360159 | (05) | AZ |