Provider Demographics
NPI:1417013491
Name:TANNER, JUNE MARIE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:MARIE
Last Name:TANNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16628
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6628
Mailing Address - Country:US
Mailing Address - Phone:904-646-0735
Mailing Address - Fax:904-805-8816
Practice Address - Street 1:2718 LANTANA LAKES DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3675
Practice Address - Country:US
Practice Address - Phone:904-545-0160
Practice Address - Fax:904-805-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health