Provider Demographics
NPI:1457929093
Name:TANNER, KATIUSKA (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:KATIUSKA
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6692 59TH CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-5210
Mailing Address - Country:US
Mailing Address - Phone:305-799-4008
Mailing Address - Fax:
Practice Address - Street 1:6692 59TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-5210
Practice Address - Country:US
Practice Address - Phone:305-799-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health