Provider Demographics
NPI:1316612732
Name:WAYNE, TANYA (LMFT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7404
Mailing Address - Country:US
Mailing Address - Phone:860-281-2280
Mailing Address - Fax:860-499-3514
Practice Address - Street 1:123 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7404
Practice Address - Country:US
Practice Address - Phone:860-281-2280
Practice Address - Fax:860-499-3514
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist