Provider Demographics
NPI:1508049339
Name:ALLEN BUSH, TAMARA DAWN (LPCC, LPC, NCC, CSAT)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:DAWN
Last Name:ALLEN BUSH
Suffix:
Gender:F
Credentials:LPCC, LPC, NCC, CSAT
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:DAWN
Other - Last Name:ALLEN-WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, NCC
Mailing Address - Street 1:520 E VINE ST # 885
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2300
Mailing Address - Country:US
Mailing Address - Phone:817-713-7223
Mailing Address - Fax:
Practice Address - Street 1:520 E. VINE ST.
Practice Address - Street 2:#885
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2300
Practice Address - Country:US
Practice Address - Phone:817-713-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-15
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091041101YM0800X
TX15194101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional