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Individual

MR. TERRANCE NEIL TANNER

Active
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Individual

MR. TERRANCE NEIL TANNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1041C0700X
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000282686
ANTHEM BCBS #
IN
01
—
000000856457
ANTHEM
IN
05
—
300006930
—
IN
01
—
P01672681
RR MEDICARE
IN
Enumeration date
07/20/2005
Last updated
03/17/2023
About Stedi
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