| Doctor Name: | SUZANNE TANNER |
| NPI Number: | 1710111018 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPEI |
| License Number: | 94-13EI |
| Business Practice Address: | 4701 Fairway Ave N Little Rock, AR - 721168066 |
| Business Phone Number: | 5017718261 |
| Business Fax Number: | |
| Mailing Address: | 4013 Lakeshore Dr, N LITTLE ROCK |
| State: | AR |
| Postal Code: | 721167469 |
| Phone Number: | 5017531855 |
| Fax Number: | |
| NPI Enumeration Date: | 05/14/2009 |
| NPI Last Update Date: | 05/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 94-13EI |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |