Provider Demographics
NPI:1477655421
Name:TANGARI, GREGORY R (LSCSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:TANGARI
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 W 6TH ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-830-8299
Mailing Address - Fax:785-749-2581
Practice Address - Street 1:2619 W 6TH ST.
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:785-749-2581
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068981OtherBLUE CROSS BLUE SHIELD