Provider Demographics
NPI:1609832963
Name:TANNIS, ROY (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:TANNIS
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAHC-DST, CMR 431, BOX 2866
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09175
Mailing Address - Country:DE
Mailing Address - Phone:49615-169-6666
Mailing Address - Fax:
Practice Address - Street 1:USAHC-DST, CMR 431, BOX 2866
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09175
Practice Address - Country:DE
Practice Address - Phone:49615-169-6666
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340019621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical