Organization
CASEY TANNER LLC
Active
Other names
THE EXPANSIVE GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY TANNER LCPC (MANAGING OWNER)
(847) 849-9237
Entity
Organization
Contact information
Practice address
2210 W WABANSIA AVE, CHICAGO, IL 60647-5477
(847) 849-9237
Mailing address
2210 W WABANSIA AVE, CHICAGO, IL 60647-5477
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261Q00000X
Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/16/2021
Last updated
08/16/2021
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