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General NPI Number Information
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NPI Number | 1699326090
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Entity Type | Individual
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Provider Name | TANYA LANE SLATER
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 13971 N CLEVELAND AVE STE 9
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-4392
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Country | US
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Telephone | 239-997-7770
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Fax | 239-997-7776
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Provider Business Mailing Address
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Address Line | 13971 N CLEVELAND AVE STE 9
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-4392
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Country | US
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Telephone | 239-997-7770
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Fax | 239-997-7776
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 50516
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 121425
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 190
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADC011451-2015
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License Number State | FL
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