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Provider Information for 1235500851


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TANIKA BLACK MA, LPC, BSN, RN


Sex: Female

NPI: 1235500851
Last Updated: 2023-05-18
Certification Date: 2023-05-18

Details

NameValue
NPI1235500851
Enumeration Date2015-10-08
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 518 JOEL ST
MINDEN, LA 71055-5206
United States

Phone: 318-268-5330 | Fax:318-377-5868
 
Primary Practice Address 518 JOEL ST
MINDEN, LA 71055-5206
United States

Phone: 318-268-5330 | Fax:318-377-5868
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 163W00000X - Registered Nurse LARN133534
Yes 101YM0800X - Counselor - Mental Health