Provider Demographics
NPI:1235839440
Name:NOELLE ERTMAN, TAMMIE LYNN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYNN
Last Name:NOELLE ERTMAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4871
Mailing Address - Country:US
Mailing Address - Phone:360-619-2643
Mailing Address - Fax:
Practice Address - Street 1:819 SE 14TH LOOP
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4891
Practice Address - Country:US
Practice Address - Phone:360-619-2643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61232094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health