Provider Demographics
NPI:1306380126
Name:TAYLOR, TAMARA CHARMAINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:CHARMAINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OAK BOURNE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1882
Mailing Address - Country:US
Mailing Address - Phone:817-739-7393
Mailing Address - Fax:
Practice Address - Street 1:3000 OAK BOURNE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1882
Practice Address - Country:US
Practice Address - Phone:817-739-7393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional