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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497995088 NPPES
South Dakota MEDICAID 5200110

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