Individual
MRS. TANYA L MAGNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LADC
Contact information
Practice address
300 E WOLF ST, MADILL, OK 73446
(580) 730-0168
(580) 872-4661
Mailing address
300 E WOLF ST, MADILL, OK 73446
(580) 730-0168
(580) 872-4661
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
845
OK
101YP2500X
Professional Counselor
Primary
3695
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SC200463720-A
—
OK
Enumeration date
06/12/2007
Last updated
09/25/2019
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