Provider Demographics
NPI:1932374592
Name:MELVIN A. TANN, ACSW, LCSW, LLC
Entity Type:Organization
Organization Name:MELVIN A. TANN, ACSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:AVON
Authorized Official - Last Name:TANN
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:314-644-4600
Mailing Address - Street 1:7750 CLAYTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1341
Mailing Address - Country:US
Mailing Address - Phone:314-644-4600
Mailing Address - Fax:314-644-3274
Practice Address - Street 1:7750 CLAYTON RD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1341
Practice Address - Country:US
Practice Address - Phone:314-644-4600
Practice Address - Fax:314-644-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0039131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO117385OtherANTHEM BLUE CROSS & BLUE SHIELD
MO5791112OtherAETNA
MO496893306Medicaid
MO5628917OtherCIGNA
MO120062OtherVALUEOPTIONS
MOR22291OtherMERCY
MO111089000OtherCOMMUNITY CAREPLUS
MO196019OtherMHNET
MO19323745924OtherMEDICARE ORGANIZATION
MO270157OtherPRINCIPAL LIFE INS. CO.
MO196019OtherMHNET