Provider Demographics
NPI:1063498103
Name:CARLISLE-JENNINGS, TAMMIE (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:CARLISLE-JENNINGS
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 1:6900 I-40 W
Mailing Address - Street 2:SUITE 190-A
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2507
Mailing Address - Country:US
Mailing Address - Phone:806-584-4395
Mailing Address - Fax:806-355-0099
Practice Address - Street 1:6900 I-40 W
Practice Address - Street 2:SUITE 190-A
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2507
Practice Address - Country:US
Practice Address - Phone:806-584-4395
Practice Address - Fax:806-355-0099
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional