Provider Demographics
NPI:1366441578
Name:WHITE, TAMRA (LPC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:WHITE
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 1:2705 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4302
Mailing Address - Country:US
Mailing Address - Phone:940-224-0105
Mailing Address - Fax:817-488-9656
Practice Address - Street 1:2485 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6686
Practice Address - Country:US
Practice Address - Phone:940-224-0105
Practice Address - Fax:817-488-9656
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16685101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286692OtherMHN
TX123743OtherSUPERIOR
TX7856443OtherAETNA BEHAVIORAL HEALTH
TX145671701Medicaid
TX6137LCOtherBLUE CROSS BLUE SHIELD