Provider Demographics
NPI:1043823560
Name:O'LEARY, TANYA BETH
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:BETH
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 N HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-2286
Mailing Address - Country:US
Mailing Address - Phone:507-825-6720
Mailing Address - Fax:507-825-6727
Practice Address - Street 1:1091 N HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-2286
Practice Address - Country:US
Practice Address - Phone:507-825-6720
Practice Address - Fax:507-825-6727
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)