Provider Information for 1457929093
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KATIUSKA TANNER LMHC, NCC
Sex: Female
NPI: 1457929093
Last Updated: 2022-11-19
Certification Date: 2022-11-19
Certification Date: 2022-11-19
Details
| Name | Value | ||||||||
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| NPI | 1457929093 | ||||||||
| Enumeration Date | 2021-06-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6692 59TH CT VERO BEACH, FL 32967-5210 United States Phone: 305-799-4008 | Fax: | ||||||||
| Primary Practice Address | 6692 59TH CT VERO BEACH, FL 32967-5210 United States Phone: 305-799-4008 | Fax: | ||||||||
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