Provider Demographics
NPI:1508052564
Name:LEININGER, TAMARA (LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LEININGER
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:EADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, NCC
Mailing Address - Street 1:775 WEATHERLY DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8910
Mailing Address - Country:US
Mailing Address - Phone:877-467-3123
Mailing Address - Fax:
Practice Address - Street 1:775 WEATHERLY DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8910
Practice Address - Country:US
Practice Address - Phone:877-467-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
KY1155101YP2500X
TN4080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID NUMBER