Provider Demographics
NPI:1881131332
Name:TANNER, MICHELLE (LPC-S, NCC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 KEWANEE AVE BLDG 10
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7048
Mailing Address - Country:US
Mailing Address - Phone:806-319-7400
Mailing Address - Fax:806-375-3222
Practice Address - Street 1:7021 KEWANEE AVE BLDG 10
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7048
Practice Address - Country:US
Practice Address - Phone:806-319-7400
Practice Address - Fax:806-375-3222
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74007101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health