Provider Demographics
NPI:1093494478
Name:MELIOR, TANNER GLEN (ACMHC)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:GLEN
Last Name:MELIOR
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S 300 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3201
Mailing Address - Country:US
Mailing Address - Phone:801-850-9147
Mailing Address - Fax:
Practice Address - Street 1:34 S 300 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3201
Practice Address - Country:US
Practice Address - Phone:801-850-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13455626-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health