Provider Demographics
NPI:1497887830
Name:TANNER, KATHY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:TANNER
Suffix:
Gender:F
Credentials:MFT
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 3913
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-3913
Mailing Address - Country:US
Mailing Address - Phone:530-546-1957
Mailing Address - Fax:530-546-1939
Practice Address - Street 1:5225 NORTH LAKE BLVD.
Practice Address - Street 2:
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140
Practice Address - Country:US
Practice Address - Phone:530-546-1957
Practice Address - Fax:530-546-1939
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist