Provider Demographics
NPI:1043326051
Name:CORRALES, TAMARA LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEIGH
Last Name:CORRALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:CORRALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:129 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4655
Mailing Address - Country:US
Mailing Address - Phone:512-868-6367
Mailing Address - Fax:512-864-0930
Practice Address - Street 1:1504 LEANDER RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8801
Practice Address - Country:US
Practice Address - Phone:512-868-6367
Practice Address - Fax:512-864-0930
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18986101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1660409Medicaid
TX6560LCOtherBLUE CROSS BLUE SHIELD