Provider Demographics
NPI:1154150027
Name:FUENTES, TANYA LEA (MC, LAC)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LEA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 7TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2509
Mailing Address - Country:US
Mailing Address - Phone:520-200-7157
Mailing Address - Fax:
Practice Address - Street 1:201 E SENECA DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6831
Practice Address - Country:US
Practice Address - Phone:520-200-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-08180T101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor