Provider Demographics
NPI:1275526436
Name:TASKER, WAYNE E (LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:E
Last Name:TASKER
Suffix:
Gender:M
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4643
Mailing Address - Country:US
Mailing Address - Phone:423-581-8844
Mailing Address - Fax:423-318-3050
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4643
Practice Address - Country:US
Practice Address - Phone:423-581-8844
Practice Address - Fax:423-318-3050
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000394101YP2500X
TNLSW00000012081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3694688Medicaid
TN3694688Medicare ID - Type Unspecified