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General NPI Number Information
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NPI Number | 1932374592
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Entity Type | Organization
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Legal Business Name | MELVIN A. TANN, ACSW, LCSW, LLC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 7750 CLAYTON RD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1341
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Country | US
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Telephone | 314-644-4600
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Fax | 314-644-3274
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Provider Business Mailing Address
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Address Line | 7750 CLAYTON RD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1341
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Country | US
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Telephone | 314-644-4600
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Fax | 314-644-3274
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Authorized Official
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Title or Position | OWNER
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Name | MR. MELVIN AVON TANN
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Credential | ACSW, LCSW
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Telephone | 314-644-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW003913
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License Number State | MO
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