Provider Demographics
NPI:1093917189
Name:TABOR-GLANCY, TAMARA LYNN (MED, CRC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNN
Last Name:TABOR-GLANCY
Suffix:
Gender:F
Credentials:MED, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9318
Mailing Address - Country:US
Mailing Address - Phone:330-544-0490
Mailing Address - Fax:330-544-1196
Practice Address - Street 1:1180 SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9318
Practice Address - Country:US
Practice Address - Phone:330-544-0490
Practice Address - Fax:330-544-1196
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00047987 CRC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator