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General NPI Number Information
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NPI Number | 1386374585
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Entity Type | Individual
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Provider Name | MACKENZIE TANNER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | 8163 GRAND RIVER RD STE 100
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City | BRIGHTON
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State | MI
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Zip | 48114-9482
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Country | US
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Telephone | 810-225-3417
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Fax |
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Provider Business Mailing Address
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Address Line | 5877 STAGHORN DR
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City | TOLEDO
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State | OH
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Zip | 43614-4564
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Country | US
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Telephone | 937-776-4995
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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