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General NPI Number Information
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NPI Number | 1366389470
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Entity Type | Individual
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Provider Name | TANNER LAWLIS LPC-ASSOCIATE
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Gender | Male
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 8103 BRODIE LN STE 1
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City | AUSTIN
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State | TX
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Zip | 78745-7475
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Country | US
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Telephone | 210-981-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 12950 LEGEND CAVE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 101431
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License Number State | TX
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