Provider Demographics
NPI:1013380930
Name:JERRY, TAMMY (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:JERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 W STATELINE RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71749-9430
Mailing Address - Country:US
Mailing Address - Phone:870-314-9921
Mailing Address - Fax:870-621-0088
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:AR
Practice Address - Zip Code:71749-9597
Practice Address - Country:US
Practice Address - Phone:870-314-9921
Practice Address - Fax:870-621-0088
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5405101YP2500X
ARP2103163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional