Healthcare Provider Details

I. General information

NPI: 1518298900
Provider Name (Legal Business Name): MINDY TANNER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDY ATKINSON LMHC

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MESCALERO RD
ROSWELL NM
88201-6542
US

IV. Provider business mailing address

PO BOX 1978
ROSWELL NM
88202-1978
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-1480
  • Fax: 575-622-3325
Mailing address:
  • Phone: 575-623-1480
  • Fax: 575-622-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0128101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: