Basic Information
| Provider Information | |||||||||
| NPI: | 1477655421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANGARI | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2619 W 6TH ST. | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858308299 | ||||||||
| FaxNumber: | 7857492581 | ||||||||
| Practice Location | |||||||||
| Address1: | 2619 W 6TH ST. | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858308299 | ||||||||
| FaxNumber: | 7857492581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1740 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 068981 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER |