Provider Demographics
NPI:1073963856
Name:ANDERSON, TAMMIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:
Last Name:ANDERSON
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 1:218 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-5715
Mailing Address - Country:US
Mailing Address - Phone:903-593-9141
Mailing Address - Fax:903-593-9865
Practice Address - Street 1:218 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5715
Practice Address - Country:US
Practice Address - Phone:903-593-9141
Practice Address - Fax:903-593-9865
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health