Individual
MS. TANYA M MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
9666 OLIVE BLVD, SUITE 400, SAINT LOUIS, MO 63132-3013
(314) 785-7274
Mailing address
6732 CREST AVE, 1ST FLOOR, SAINT LOUIS, MO 63130-2506
(314) 704-3623
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2010037457
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548561046
—
MO
Enumeration date
11/15/2010
Last updated
12/30/2014
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