Healthcare Provider Details

I. General information

NPI: 1174213664
Provider Name (Legal Business Name): MAEGAN TANNER AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 K ST
SACRAMENTO CA
95816-6082
US

IV. Provider business mailing address

2430 K ST
SACRAMENTO CA
95816-6082
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-4958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12082
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: