MEDICARE: KATHY ANN TANNER M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	39047	CA

General Provider Information

NPI Number	:	1497887830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ANN TANNER M.F.T.

Provider Business Mailing Address
First Line	:	PO BOX 3913
Second Line	:
City	:	TRUCKEE
State	:	CA
Zip	:	96160-3913
Country	:	US
Telephone Number	:	530-546-1957
Fax Number	:	530-546-1939

Provider Business Practice Location Address
First Line	:	5225 NORTH LAKE BLVD.
Second Line	:
City	:	CARNELIAN BAY
State	:	CA
Zip	:	96140
Country	:	US
Telephone Number	:	530-546-1957
Fax Number	:	530-546-1939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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