Individual
TANESHA MICHELE LIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1051 SOUTH CUSHMAN STREET, FAIRBANKS, AK 99701
(907) 388-6817
Mailing address
1051 SOUTH CUSHMAN STREET, FAIRBANKS, AK 99709
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE
—
AK
Enumeration date
08/27/2021
Last updated
08/27/2021
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