Provider Demographics
NPI:1235504473
Name:RENDER-MORRIS, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:RENDER-MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 OLD OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1348
Mailing Address - Country:US
Mailing Address - Phone:720-401-4214
Mailing Address - Fax:
Practice Address - Street 1:1401 E LANSING DR STE 106
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2992
Practice Address - Country:US
Practice Address - Phone:720-401-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional