| Doctor Name: | TANYA IVANIVNA HALLGREN |
| NPI Number: | 1104067974 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.ED., LPC |
| License Number: | CERTIFICATE #3429 |
| Business Practice Address: | 2960 Tongass Avenue First Floor Ketchikan Indian Community Tribal Health Cl Ketchikan, AK - 99901 |
| Business Phone Number: | 9072284917 |
| Business Fax Number: | 9072284920 |
| Mailing Address: | 2960 Tongass Avenue, First Floor Ketchikan Indian Community Tribal Health Cl KETCHIKAN |
| State: | AK |
| Postal Code: | 99901 |
| Phone Number: | 9072284917 |
| Fax Number: | 9072284920 |
| NPI Enumeration Date: | 03/09/2009 |
| NPI Last Update Date: | 03/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CERTIFICATE #3429 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |