Provider Demographics
NPI:1376137182
Name:LANGSTON, TAMARA TYRENEE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:TYRENEE
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25071 MORNING DOVE WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-9214
Mailing Address - Country:US
Mailing Address - Phone:909-485-7449
Mailing Address - Fax:
Practice Address - Street 1:25071 MORNING DOVE WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-9214
Practice Address - Country:US
Practice Address - Phone:909-485-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician