Provider Demographics
NPI:1073258299
Name:PACHECO, TAMARA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 THUNDER RD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8031
Mailing Address - Country:US
Mailing Address - Phone:513-226-5648
Mailing Address - Fax:
Practice Address - Street 1:9435 WATERSTONE BLVD STE 140-46
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-8226
Practice Address - Country:US
Practice Address - Phone:513-226-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102661101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor