Provider Demographics
NPI:1508552548
Name:AUSTIN, TAMAR SHAWNICE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:SHAWNICE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1327
Mailing Address - Country:US
Mailing Address - Phone:267-257-4780
Mailing Address - Fax:
Practice Address - Street 1:5533 MORTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1327
Practice Address - Country:US
Practice Address - Phone:267-257-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional