Provider Demographics
NPI:1043591860
Name:NORTHING, TAMMY R
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:R
Last Name:NORTHING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5026
Mailing Address - Country:US
Mailing Address - Phone:417-781-3616
Mailing Address - Fax:417-781-4190
Practice Address - Street 1:1211 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5026
Practice Address - Country:US
Practice Address - Phone:417-781-3616
Practice Address - Fax:417-781-4190
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011022415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst