Provider Demographics
NPI:1528784584
Name:MUMM, TONYA (TLMHC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:MUMM
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3749
Mailing Address - Country:US
Mailing Address - Phone:166-020-2918
Mailing Address - Fax:
Practice Address - Street 1:505 5TH ST STE 310
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1508
Practice Address - Country:US
Practice Address - Phone:712-258-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health