Provider Demographics
NPI:1346581048
Name:CORMIER, TANYA CARRON (LPC, RN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:CARRON
Last Name:CORMIER
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WILLOW WOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-6459
Mailing Address - Country:US
Mailing Address - Phone:337-781-7101
Mailing Address - Fax:337-456-4830
Practice Address - Street 1:404 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3626
Practice Address - Country:US
Practice Address - Phone:337-306-2781
Practice Address - Fax:877-286-8862
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5497101Y00000X, 101YP2500X
LA086870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse