Provider Demographics
NPI:1558180984
Name:TANNER, GLEN ESKER (MA)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:ESKER
Last Name:TANNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CALF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-8013
Mailing Address - Country:US
Mailing Address - Phone:304-299-9214
Mailing Address - Fax:
Practice Address - Street 1:425 JULIANA ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5352
Practice Address - Country:US
Practice Address - Phone:304-893-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional