Provider Demographics
NPI:1619624376
Name:STEVENS, TANNER (CDCA)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 OHIO DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4835
Mailing Address - Country:US
Mailing Address - Phone:614-389-3030
Mailing Address - Fax:
Practice Address - Street 1:1955 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4835
Practice Address - Country:US
Practice Address - Phone:614-389-3030
Practice Address - Fax:614-413-3536
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA179901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty