Provider Demographics
NPI:1366533499
Name:HOUGH, TANYA D (PSYD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:D
Last Name:HOUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SE 22ND ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7188
Mailing Address - Country:US
Mailing Address - Phone:479-254-6707
Mailing Address - Fax:479-254-6707
Practice Address - Street 1:111 SE 22ND ST
Practice Address - Street 2:SUITE 22
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7188
Practice Address - Country:US
Practice Address - Phone:479-254-6707
Practice Address - Fax:479-254-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-16P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical