Provider Demographics
NPI:1437625910
Name:WHITE, TAMEKA T (MED, MHP)
Entity Type:Individual
Prefix:MS
First Name:TAMEKA
Middle Name:T
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19095 GORMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0346
Mailing Address - Country:US
Mailing Address - Phone:985-969-9330
Mailing Address - Fax:
Practice Address - Street 1:1320 N MORRISON BLVD STE 105&106
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2242
Practice Address - Country:US
Practice Address - Phone:985-551-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty