Individual
DR. PHILLIP LEWIS TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1 N WILLARD ST, COTTONWOOD, AZ 86326-3651
(928) 634-2288
Mailing address
1 NORTH WILLARD ST., COTTONWOOD, AZ 86326
(928) 634-2288
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
3257399
AZ
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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