Provider Demographics
NPI:1942425400
Name:BAGLEY, TONYA MARIE (A A, BA, CAS)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:MARIE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:A A, BA, CAS
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:MARIE
Other - Last Name:SNEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:A A, BA, CAS
Mailing Address - Street 1:190 E HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9001
Mailing Address - Country:US
Mailing Address - Phone:209-525-7218
Mailing Address - Fax:
Practice Address - Street 1:190 E HACKETT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9001
Practice Address - Country:US
Practice Address - Phone:209-525-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4091214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)