Provider Demographics
NPI:1104067974
Name:HALLGREN, TANYA IVANIVNA (MED, LPC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:IVANIVNA
Last Name:HALLGREN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:TETYANA
Other - Middle Name:IVANIVNA
Other - Last Name:BABYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2960 TONGASS AVENUE
Mailing Address - Street 2:FIRST FLOOR KETCHIKAN INDIAN COMMUNITY TRIBAL HEALTH CL
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:907-228-4917
Mailing Address - Fax:907-228-4920
Practice Address - Street 1:2960 TONGASS AVENUE
Practice Address - Street 2:FIRST FLOOR KETCHIKAN INDIAN COMMUNITY TRIBAL HEALTH CL
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-228-4917
Practice Address - Fax:907-228-4920
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLPC#568101Y00000X
AKCERTIFICATE #3429101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)