Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LCS 22509 | CA |
NPI | 1003175167 |
---|---|
Provider Name | Martin Patterson Tanner |
First Address | Lancaster, CA 93534-2806 |
Second Address | Lancaster, CA 93534-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2012 |
Last Update Date | 10/05/2012 |