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Individual
MR. WYATT LEE TANNER
Active
Individual
MR. WYATT LEE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW, LCDC III
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
151005
OH
104100000X
Social Worker
Primary
S.1802169
OH
Other
Enumeration date
03/13/2017
Last updated
09/19/2023
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