Provider Demographics
NPI:1164559860
Name:TAMMY MORGAN HAMNER
Entity Type:Organization
Organization Name:TAMMY MORGAN HAMNER
Other - Org Name:HAMNER PSYCHOLOGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-842-7007
Mailing Address - Street 1:917 W MAIN ST
Mailing Address - Street 2:HARRON SQUARE, SUITE 203
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1650
Mailing Address - Country:US
Mailing Address - Phone:304-842-7007
Mailing Address - Fax:304-842-7099
Practice Address - Street 1:917 W MAIN ST
Practice Address - Street 2:HARRON SQUARE, SUITE 203
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1650
Practice Address - Country:US
Practice Address - Phone:304-842-7007
Practice Address - Fax:304-842-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV #570103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9204026000Medicaid
WVSP00571Medicare PIN