Provider Demographics
NPI:1093173478
Name:TANNER, A JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:A
Middle Name:JEAN
Last Name:TANNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SAINT MATTHEWS AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3145
Mailing Address - Country:US
Mailing Address - Phone:502-930-1113
Mailing Address - Fax:502-290-6800
Practice Address - Street 1:161 SAINT MATTHEWS AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3145
Practice Address - Country:US
Practice Address - Phone:502-930-1113
Practice Address - Fax:502-290-6800
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 4111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical