Individual
DR. DUSTIN BROOKS TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
910 W HAVENS AVE, MITCHELL, SD 57301-3831
(605) 996-9686
(605) 996-1624
Mailing address
2070 NORTHERN SKY DR, TWIN FALLS, ID 83301-3900
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202804
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5200110
—
SD
Enumeration date
02/23/2009
Last updated
08/05/2015
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