Provider Demographics
NPI:1548486285
Name:YOUNGBLOOD, TANYA LYNNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYNNE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LYNNE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8847 JACARANDA UNIT D
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1358
Mailing Address - Country:US
Mailing Address - Phone:909-229-1328
Mailing Address - Fax:
Practice Address - Street 1:980 W 6TH ST STE 126
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1208
Practice Address - Country:US
Practice Address - Phone:909-229-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist