Provider Demographics
NPI:1629348925
Name:TANNEN, ELLEN KAY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:KAY
Last Name:TANNEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 SYLVALE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1622
Mailing Address - Country:US
Mailing Address - Phone:410-486-2612
Mailing Address - Fax:
Practice Address - Street 1:6801 SYLVALE CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1622
Practice Address - Country:US
Practice Address - Phone:410-805-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4052101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor