Provider Demographics
NPI:1164133740
Name:PEPIN, TAMMY LORINE (P-LPC, NCC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LORINE
Last Name:PEPIN
Suffix:
Gender:F
Credentials:P-LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 BEATLINE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4138
Mailing Address - Country:US
Mailing Address - Phone:228-346-3743
Mailing Address - Fax:
Practice Address - Street 1:4011 BEATLINE RD STE 8
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4138
Practice Address - Country:US
Practice Address - Phone:228-346-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0889101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty