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1063767796
MARY ELLEN TANNER
COVINA, CA
NPI
1063767796
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: CA LCSW73551)
Enumeration Date
2012-07-18
Last Update Date
2016-12-06
Business Address
-- MARY ELLEN TANNER LCSW
4740 N GRAND AVE
COVINA, CA 91724-2005
Phone number: 626-859-2089
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Mailing Address
-- MARY ELLEN TANNER LCSW
4740 N GRAND AVE
COVINA, CA 91724-2005
Phone number: 626-859-2089
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