Individual
JACKIE TANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1742 CHERYL ST, CLARKSDALE, MS 38614-7218
(662) 627-7267
(662) 627-5240
Mailing address
PO BOX 1046, CLARKSDALE, MS 38614-1046
(662) 627-7267
(662) 627-5240
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/15/2010
Last updated
03/15/2010
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