Provider Demographics
NPI:1346350238
Name:WANAMAKER, TAMMY LYNNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNNE
Last Name:WANAMAKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WILLIAMS DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4109
Mailing Address - Country:US
Mailing Address - Phone:512-863-9056
Mailing Address - Fax:512-233-1099
Practice Address - Street 1:1101 WILLIAMS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4109
Practice Address - Country:US
Practice Address - Phone:512-863-9056
Practice Address - Fax:512-233-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361106H00000X
TXLPC 05402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist