Provider Demographics
NPI:1508525999
Name:TANNER, TRAVIS (PHD, LMSW)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:TANNER
Suffix:
Gender:M
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6560
Mailing Address - Country:US
Mailing Address - Phone:949-689-5550
Mailing Address - Fax:
Practice Address - Street 1:2131 JOSEPH ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6560
Practice Address - Country:US
Practice Address - Phone:949-689-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS255102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst