Provider Demographics
NPI:1265506190
Name:STAR, TAMMY (LMHC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:STAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5712
Mailing Address - Country:US
Mailing Address - Phone:321-223-8003
Mailing Address - Fax:321-452-2802
Practice Address - Street 1:7777 N WICKHAM RD STE 12-224
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7976
Practice Address - Country:US
Practice Address - Phone:321-223-8003
Practice Address - Fax:321-452-2802
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7949101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008070200Medicaid
FL205636867OtherTRICARE
FL811814100Medicaid
FLZ117JOtherBCBSF