1164496394 NPI number — LAUREN ELISABETH TANCYUS LCSW

Table of content: LAUREN ELISABETH TANCYUS LCSW (NPI 1164496394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164496394 NPI number — LAUREN ELISABETH TANCYUS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANCYUS
Provider First Name:
LAUREN
Provider Middle Name:
ELISABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANCYUS
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164496394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1138
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22939-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-688-2646
Provider Business Mailing Address Fax Number:
540-668-2656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 MYERS CORNER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAUNTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24401-6342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-688-2646
Provider Business Practice Location Address Fax Number:
540-688-2656
Provider Enumeration Date:
02/15/2006

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: 1041C0700X , with the licence number:  0904003043 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087863 . This is a "OPTIMA BEHAVIORAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2228931 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1056177 . This is a "CIGNA BEHAVIORAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008936510 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8936510 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 259093 . This is a "ANTHEM BEHAVIORAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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