| Therapy Culture Llc | |
|
5763 Village Loop Fairburn GA 30213-4641 | |
| (770) 377-1563 | |
| Not Available |
| Full Name | Therapy Culture Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5763 Village Loop, Fairburn, Georgia |
| Authorized Official Name and Position | Michael W Tanner (THERAPIST) |
| Authorized Official Contact | 7703771563 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Therapy Culture Llc 5763 Village Loop Fairburn GA 30213-4641 Ph: (770) 377-1563 | Therapy Culture Llc 5763 Village Loop Fairburn GA 30213-4641 Ph: (770) 377-1563 |
| NPI Number | 1235890526 |
|---|---|
| Provider Enumeration Date | 01/07/2022 |
| Last Update Date | 02/24/2022 |
| Certification Date | 02/24/2022 |
| Medicare PECOS PAC ID | 9436693082 |
|---|---|
| Medicare Enrollment ID | O20240708000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235890526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Michael W. Tanner |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1548869183 PECOS PAC ID: 1951845510 Enrollment ID: I20240708000662 |
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