Provider Demographics
NPI:1649805474
Name:WONSEY, TIANNA
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:WONSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 S RAINBOW BLVD UNIT 233
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-8002
Mailing Address - Country:US
Mailing Address - Phone:702-613-3918
Mailing Address - Fax:
Practice Address - Street 1:7375 S PECOS RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3773
Practice Address - Country:US
Practice Address - Phone:702-900-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2025-09-25
Deactivation Date:2020-11-04
Deactivation Code:
Reactivation Date:2025-09-25
Provider Licenses
StateLicense IDTaxonomies
NVRBT-25-409540106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician