Healthcare Provider Details

I. General information

NPI: 1700448651
Provider Name (Legal Business Name): CHRISTOPHER L TENNANT MPH, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

IV. Provider business mailing address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

V. Phone/Fax

Practice location:
  • Phone: 330-787-9180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS31995
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: