Provider Demographics
NPI:1801515523
Name:JACLYN TANNER COUNSELING, LLC
Entity type:Organization
Organization Name:JACLYN TANNER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:EMILIA
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-307-5008
Mailing Address - Street 1:50 KIMBALL LN
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4417
Mailing Address - Country:US
Mailing Address - Phone:860-307-5008
Mailing Address - Fax:860-387-7567
Practice Address - Street 1:40 MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5340
Practice Address - Country:US
Practice Address - Phone:860-387-7567
Practice Address - Fax:860-387-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty