Individual
DR. GLENN DAVID TANITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.H.
Contact information
Practice address
77 CALLE PORTAL STE C240, SIERRA VISTA, AZ 85635-2986
(520) 459-3011
Mailing address
1205 N F AVE, DOUGLAS, AZ 85607-1920
(520) 459-3110
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1249
AZ
103T00000X
Psychologist
PSY-001249
AZ
Other
Enumeration date
06/10/2008
Last updated
02/20/2024
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