MEDICARE: MAURIA E TANNER MTRS/CTRS/CPCI

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	101YP2500X	Professional Counselor	285787-6009	UT

General Provider Information

NPI Number	:	1649354127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURIA E TANNER MTRS/CTRS/CPCI

Provider Business Mailing Address
First Line	:	9511 HILLSBOROUGHHEIGHTS RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-3321
Country	:	US
Telephone Number	:	801-671-0735
Fax Number	:

Provider Business Practice Location Address
First Line	:	8817 REDWOOD RD STE A
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9266
Country	:	US
Telephone Number	:	801-748-2270
Fax Number	:	801-748-2271

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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