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General NPI Number Information
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NPI Number | 1427565977
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Entity Type | Organization
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Legal Business Name | TANNER COMMUNITY DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 700 E JEFFERSON ST STE 200
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City | PHOENIX
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State | AZ
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Zip | 85034-2202
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Country | US
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Telephone | 602-253-6904
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Fax | 602-253-2723
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Provider Business Mailing Address
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Address Line | 700 E JEFFERSON ST STE 200
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City | PHOENIX
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State | AZ
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Zip | 85034-2202
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Country | US
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Telephone | 602-253-6904
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Fax | 602-253-2723
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. DARLENE LITTLE
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Credential |
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Telephone | 602-253-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 50216
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License Number State | AZ
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