Provider Demographics
NPI:1699337279
Name:DEPEIZA, TANYA (LCSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DEPEIZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 STATE HIGHWAY 121 BYP APT 2317
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4130
Mailing Address - Country:US
Mailing Address - Phone:773-827-2777
Mailing Address - Fax:
Practice Address - Street 1:351 STATE HIGHWAY 121 BYP APT 2317
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4130
Practice Address - Country:US
Practice Address - Phone:773-827-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical