Basic Information
| Provider Information | |||||||||
| NPI: | 1538615810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNAIR | ||||||||
| FirstName: | TAWANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| OtherLastName: | MCNAIR | ||||||||
| OtherFirstName: | TAWANA | ||||||||
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| OtherCredential: | M.A | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2285 PINECREEK DRIVE C-116 | ||||||||
| Address2: | C-116 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185769961 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1901 CARNEGIE AVENUE | ||||||||
| Address2: | SUITE 1-C | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148488319 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.