=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942038757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANNER MCKENZIE MEYER LMSW
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2024
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11709 OLD BALLAS RD STE 203
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-956-5531
-----------------------------------------------------
Fax | 314-594-4301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1735 REDBIRD CV
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63144-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-610-9269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2024040957
-----------------------------------------------------
License Number State |
-----------------------------------------------------