Individual
TANYA M AMOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
230 W PARK STREET, WAUTOMA, WI 54982-9031
(920) 787-6550
(920) 787-0421
Mailing address
PO BOX 1230, WAUTOMA, WI 54982-1230
(920) 787-6550
(920) 787-0421
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4648-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265714455
—
WI
Enumeration date
09/13/2011
Last updated
01/16/2015
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