1013349216 NPI number — DR. TANYA SIMONE CRABB PSY.D.

Table of content: DR. TANYA SIMONE CRABB PSY.D. (NPI 1013349216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013349216 NPI number — DR. TANYA SIMONE CRABB PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRABB
Provider First Name:
TANYA
Provider Middle Name:
SIMONE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIBBERT
Provider Other First Name:
TANYA
Provider Other Middle Name:
SIMONE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013349216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 BLUE RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGECREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93555-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-213-2786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FAMILY COURT LIAISON BRANCH
Provider Second Line Business Practice Location Address:
42-470 KALANIAOLE HWY., COTTAGE 3
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-266-9922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  60890986 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)