Individual
BARRY A TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4201 SAINT ANTOINE ST, LIFE STRESS CENTER 3S-14, DETROIT, MI 48201-2153
(313) 745-4811
(313) 966-7196
Mailing address
4201 SAINT ANTOINE ST, LIFE STRESS CENTER 3S-14, DETROIT, MI 48201-2153
(313) 745-4811
(313) 966-7196
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301002031
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11290248
CAQH PID
—
Enumeration date
03/19/2007
Last updated
07/08/2007
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