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Individual

MR. MELVIN AVON TANN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ACSW, LCSW

Contact information

Practice address
7750 CLAYTON RD STE 300, SAINT LOUIS, MO 63117-1341
(314) 644-4600
(314) 644-3274
Mailing address
7750 CLAYTON RD STE 300, SAINT LOUIS, MO 63117-1341
(314) 644-4600
(314) 644-3274

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW003913
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
193237459
MEDICARE ORGANIZATION NPI
MO
05
496893306
MO
Enumeration date
08/08/2006
Last updated
03/19/2012
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