Individual
MS. MAIKE L TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
24 COUNTRY CLUB LANE, PINEDALE, WY 82941
(307) 367-2111
(307) 367-2166
Mailing address
PO BOX 856, PINEDALE, WY 82941-0856
(307) 367-2111
(307) 367-2166
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-605
WY
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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