Individual
MR. JASON MATTHEW TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
372 S GREENO RD, FAIRHOPE, AL 36532-1916
(251) 990-4243
(251) 928-0126
Mailing address
372 S GREENO RD, FAIRHOPE, AL 36532-1916
(251) 990-4243
(251) 928-0126
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0873C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051530538
BLUE CROSS/ BLUE SHIELD
AL
Enumeration date
08/21/2008
Last updated
08/21/2008
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