Provider Demographics
NPI:1306280987
Name:FANNING, PATRICIA TAPP (LPC/MHSP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:TAPP
Last Name:FANNING
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:STARBIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC/MHSP
Mailing Address - Street 1:100 5TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-5919
Mailing Address - Country:US
Mailing Address - Phone:865-281-1408
Mailing Address - Fax:865-244-3579
Practice Address - Street 1:100 5TH ST STE 310
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-5919
Practice Address - Country:US
Practice Address - Phone:865-281-1408
Practice Address - Fax:865-244-3579
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004887101YP2500X
TNLPC0000001774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPC0000001774OtherLPC
VALPC0701004887OtherLPC