Provider Demographics
NPI:1043709108
Name:TAMMY MAREK
Entity Type:Organization
Organization Name:TAMMY MAREK
Other - Org Name:DEPRESSION, ANXIETY AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-647-1188
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:MONT BELVIEU
Mailing Address - State:TX
Mailing Address - Zip Code:77580-1611
Mailing Address - Country:US
Mailing Address - Phone:936-647-1188
Mailing Address - Fax:936-647-1212
Practice Address - Street 1:4721 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2153
Practice Address - Country:US
Practice Address - Phone:936-647-1188
Practice Address - Fax:936-647-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043709108OtherNPI 2
TX1194082792OtherNPI
TX3007593Medicaid