Individual
TANNER JACOB BENEDICT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, BCBA, LBA
Contact information
Practice address
14510 W SHUMWAY DR STE 200, SUN CITY WEST, AZ 85375-5817
(623) 401-1232
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-25-85793
AZ
103K00000X
Behavior Analyst
Primary
BEH-001923
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-25-85793
BCBA-CERTIFICATE
—
Enumeration date
06/25/2021
Last updated
06/12/2026
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