Provider Demographics
NPI:1821883679
Name:WEEKS, TANNER
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:WEEKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28009 CAMINO DEL RIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5375
Mailing Address - Country:US
Mailing Address - Phone:949-613-0155
Mailing Address - Fax:
Practice Address - Street 1:28009 CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-5375
Practice Address - Country:US
Practice Address - Phone:949-613-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician