Organization
TANNER LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANITA TANNER (DIRECTOR)
(808) 635-8057
Entity
Organization
Contact information
Practice address
916 6TH ST, LAS VEGAS, NM 87701-4307
(808) 635-8057
Mailing address
932 GALLINAS ST, LAS VEGAS, NM 87701-3891
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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