Provider Demographics
NPI:1588942106
Name:HEALY, TINA RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:RENEE
Last Name:HEALY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:RENEE
Other - Last Name:ALONZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:8200 STOCKDALE HWY STE M10-217
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1091
Mailing Address - Country:US
Mailing Address - Phone:661-472-9433
Mailing Address - Fax:
Practice Address - Street 1:1018 21ST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4709
Practice Address - Country:US
Practice Address - Phone:661-861-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical