MEDICARE: MS. JUNE MARIE TANNER L.M.H.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 6427	FL

General Provider Information

NPI Number	:	1417013491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUNE MARIE TANNER L.M.H.C.

Provider Business Mailing Address
First Line	:	PO BOX 16628
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-6628
Country	:	US
Telephone Number	:	904-646-0735
Fax Number	:	904-805-8816

Provider Business Practice Location Address
First Line	:	2718 LANTANA LAKES DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-3675
Country	:	US
Telephone Number	:	904-545-0160
Fax Number	:	904-805-8816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/09/2007

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