Individual
JOHN TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4515 MENCHACA RD STE 204, AUSTIN, TX 78745-1645
(203) 570-3081
Mailing address
4515 MENCHACA RD STE 204, AUSTIN, TX 78745-1645
(203) 570-3081
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
18014
TX
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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