Provider Demographics
NPI:1255543880
Name:TANNER, CATHY CHRISTINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:CHRISTINE
Last Name:TANNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:CHRISTINE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 WRIGHTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8571
Mailing Address - Country:US
Mailing Address - Phone:731-298-6388
Mailing Address - Fax:
Practice Address - Street 1:25 SECURITY DR
Practice Address - Street 2:JORDAN PROFESSIONAL COUNSELING
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3754
Practice Address - Country:US
Practice Address - Phone:731-298-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001861101YM0800X
TNLPC0000002380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health