Glenn David Tanita, D.M.H.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1249 Issued in AZ

Practice address

77 Calle Portal Ste C240
Sierra Vista, AZ 85635-2986

Phone

(520) 459-3011

NPI assigned

Jun 10, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chiricahua Community Health Centers IncGroup PAC ID 5395638878, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1942241443

  AZ

  Medicare reassignment Care Compare group NPD
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Benson, AZ
  • NPI 1821582529
  Care Compare group NPD
• Chiricahua Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Willcox, AZ
  • NPI 1285488866
  Care Compare group NPD
• Chiricahua Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1124803648
  Care Compare group
• Chiricahua Community Health Centers Inc

  • Pharmacy
  • Sierra Vista, AZ
  • NPI 1558882233
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Bisbee, AZ
  • NPI 1063540144
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Douglas, AZ
  • NPI 1174820898
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Sierra Vista, AZ
  • NPI 1184407546
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Sierra Vista, AZ
  • NPI 1205547288
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Sierra Vista, AZ
  • NPI 1417331711
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Elfrida, AZ
  • NPI 1457489890
  Care Compare group
• Chiricahua Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Bisbee, AZ
  • NPI 1710462593
  Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1669632006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 N F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071920",
            "telephone_number": "520-459-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 CALLE PORTAL STE C240",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352986",
            "telephone_number": "520-459-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANITA",
        "first_name": "GLENN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.M.H.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "PSY-001249",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "1249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosa Trinidad C Tabanda-Lichauco, M.D.
• Rachael Taillie, RN
• Sarah Talamantes, LMT
• Irene Brandi Tan, OD
• Andrew Tang, DO
• Deborah Tanner, ACNP-BC
• Lisa N Tant, N.P.
• Tap Into Motion PLLC
• Tap Into Wellness PLLC
• Robert Lane Tassin, MD

• All providers in Sierra Vista, AZ
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.