Provider Demographics
NPI:1730876988
Name:LOOBY, TANYA CRYSTAL
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:CRYSTAL
Last Name:LOOBY
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 1:3990 HITCHCOCK RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-6327
Mailing Address - Country:US
Mailing Address - Phone:478-228-1671
Mailing Address - Fax:
Practice Address - Street 1:3990 HITCHCOCK RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-6327
Practice Address - Country:US
Practice Address - Phone:478-228-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical