Provider Demographics
NPI:1407123441
Name:TANNER, PATRICK G (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:TANNER
Suffix:
Gender:M
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RYLAND ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2214
Mailing Address - Country:US
Mailing Address - Phone:775-322-1534
Mailing Address - Fax:775-322-1530
Practice Address - Street 1:131 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2214
Practice Address - Country:US
Practice Address - Phone:775-322-1534
Practice Address - Fax:775-322-1530
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist