Doctor Name: | MITCH TARVER |
NPI Number: | 1679972111 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 3601C |
Business Practice Address: | 151 Hamilton Ln Calera, AL - 350408700 |
Business Phone Number: | 2056684308 |
Business Fax Number: | 2056680894 |
Mailing Address: | Po Box 689, CALERA |
State: | AL |
Postal Code: | 350400689 |
Phone Number: | 2056684308 |
Fax Number: | 2056680894 |
NPI Enumeration Date: | 08/21/2014 |
NPI Last Update Date: | 08/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 3601C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |