Active NPI
John Tanner, PHD
- Clinical Psychologist
- Austin, TX
National Provider Identifier
1871283564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 18014
- Practice address
- 4515 Menchaca Rd Ste 204
Austin, TX 78745-1645 - Phone
- (203) 570-3081
- NPI assigned
- May 8, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 18014 | TX | Primary |
Addresses
Primary practice location
4515 Menchaca Rd Ste 204
Austin, TX 78745-1645
Mailing address
4515 Menchaca Rd Ste 204
Austin, TX 78745-1645
Phone (203) 570-3081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 4, 2025 through Sep 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18014 | TX | MD | Clinical Psychologist |
| 39604 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1871283564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4515 MENCHACA RD STE 204",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787451645",
"telephone_number": "203-570-3081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4515 MENCHACA RD STE 204",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787451645",
"telephone_number": "203-570-3081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANNER",
"first_name": "JOHN",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "18014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.