1639539117 NPI number — CHRISTINA NOLAN TANNER LCSW

Table of content: CHRISTINA NOLAN TANNER LCSW (NPI 1639539117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639539117 NPI number — CHRISTINA NOLAN TANNER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANNER
Provider First Name:
CHRISTINA
Provider Middle Name:
NOLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOLAN
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
BUTLER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639539117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 UPLAND DR # 1403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77043-4718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-617-9148
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 EAST 39TH STREET
Provider Second Line Business Practice Location Address:
SUITE 800 OFFICE W
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-617-9148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  079931 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)