Provider Demographics
NPI:1457452179
Name:REMBOLT, TAMI ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:ANNE
Last Name:REMBOLT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-1262
Mailing Address - Country:US
Mailing Address - Phone:660-619-0591
Mailing Address - Fax:660-438-5746
Practice Address - Street 1:1238 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3157
Practice Address - Country:US
Practice Address - Phone:660-619-0591
Practice Address - Fax:660-438-5746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040045921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497177501Medicaid
MO757177506Medicaid
MOT69C882Medicare ID - Type UnspecifiedIND. MEDICARE WITH TLC