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NPI Code Detail

MEDICARE: MARIANNE GRACE TAN MFT (TEMP)

MEDICARE: MARIANNE GRACE TAN MFT (TEMP)
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
1106H00000XMarriage & Family Therapist2689TN

General Provider Information

NPI Number : 1881550192
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNE GRACE TAN MFT (TEMP)
Provider Business Mailing Address
First Line : 5300 CENTENNIAL BLVD STE 210
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-1696
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5300 CENTENNIAL BLVD STE 210
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-1696
Country : US
Telephone Number : 615-882-4196
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2025
Last Update Date : 12/30/2025

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