Provider Demographics
NPI:1346940814
Name:ADDIS, TAMARA L (MED, LPC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:ADDIS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:ADDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8675 HUMMINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4516
Mailing Address - Country:US
Mailing Address - Phone:972-467-1846
Mailing Address - Fax:
Practice Address - Street 1:8675 HUMMINGBIRD DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4516
Practice Address - Country:US
Practice Address - Phone:972-467-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85623101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional