Provider Demographics
NPI:1225493141
Name:POWELL, TAMARA JILLANE (RMHCI)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JILLANE
Last Name:POWELL
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E ZARAGOZA ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6154
Mailing Address - Country:US
Mailing Address - Phone:850-516-9590
Mailing Address - Fax:850-332-7870
Practice Address - Street 1:435 E ZARAGOZA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6154
Practice Address - Country:US
Practice Address - Phone:850-516-9590
Practice Address - Fax:850-332-7870
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health