Tanner, Dustin Brooks
Tanner, Dustin Brooks is an individual health care provider with primary practice located at 910 W Havens Ave , Mitchell SD 57301-3831. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Tanner, Dustin Brooks can be contacted via phone (605) 996-9686.Contact Information
Primary practice address
910 W Havens Ave
Mitchell SD 57301-3831
Phone: (605) 996-9686
Fax: (605) 996-1624
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | South Dakota | |
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY-202804 | Idaho |
Profile Details
NPI number | 1497995088 |
---|---|
LBN Legal business name | Tanner, Dustin Brooks |
Credentials | PSYD |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Feb 23rd, 2009 |
Last updated | Aug 5th, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1497995088 | NPPES |
South Dakota | MEDICAID | 5200110 |
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