Provider Demographics
NPI:1174909048
Name:JEFFERSON, TANYA YANETTE
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:YANETTE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:YANETTE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3615 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4529
Mailing Address - Country:US
Mailing Address - Phone:810-820-3420
Mailing Address - Fax:
Practice Address - Street 1:806 TUURI PL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2465
Practice Address - Country:US
Practice Address - Phone:810-237-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor