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General NPI Number Information
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NPI Number | 1801515523
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Entity Type | Organization
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Legal Business Name | JACLYN TANNER COUNSELING, LLC
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 40 MAIN ST STE 9
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City | TORRINGTON
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State | CT
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Zip | 06790-5340
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Country | US
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Telephone | 860-387-7567
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Fax | 860-387-7567
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Provider Business Mailing Address
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Address Line | 50 KIMBALL LN
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City | TORRINGTON
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State | CT
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Zip | 06790-4417
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Country | US
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Telephone | 860-307-5008
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Fax | 860-387-7567
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | JACLYN EMILIA TANNER
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Credential | LPC
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Telephone | 860-307-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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