Provider Demographics
NPI:1699113233
Name:MAGINNIS, TANDI NIKOLE (CADC)
Entity type:Individual
Prefix:
First Name:TANDI
Middle Name:NIKOLE
Last Name:MAGINNIS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4730
Mailing Address - Country:US
Mailing Address - Phone:775-882-3945
Mailing Address - Fax:775-882-6126
Practice Address - Street 1:788 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5790
Practice Address - Country:US
Practice Address - Phone:775-882-3945
Practice Address - Fax:775-882-6126
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06919-C101YA0400X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner