Provider Demographics
NPI:1538892724
Name:TANNER, CATHERINE L
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:TANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BURKE LOOP
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-8700
Mailing Address - Country:US
Mailing Address - Phone:575-956-3157
Mailing Address - Fax:
Practice Address - Street 1:415 W HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3622
Practice Address - Country:US
Practice Address - Phone:575-694-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health