Provider Demographics
NPI:1295320851
Name:TANNER, TAYLOR PAIGE (LCMHC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:PAIGE
Last Name:TANNER
Suffix:
Gender:F
Credentials:LCMHC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6124
Mailing Address - Country:US
Mailing Address - Phone:828-322-4941
Mailing Address - Fax:828-322-4931
Practice Address - Street 1:439 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6124
Practice Address - Country:US
Practice Address - Phone:828-322-4941
Practice Address - Fax:828-322-4931
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health