Provider Demographics
NPI:1073228094
Name:JANUARY, TAMIKA (LPCA)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:JANUARY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12921 OBSERVATION CIR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1678
Mailing Address - Country:US
Mailing Address - Phone:502-403-6659
Mailing Address - Fax:
Practice Address - Street 1:12921 OBSERVATION CIR UNIT 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1678
Practice Address - Country:US
Practice Address - Phone:502-403-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health