Provider Demographics
NPI:1548405384
Name:PELL, TAMRA SUZANNE (MSSA, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:SUZANNE
Last Name:PELL
Suffix:
Gender:F
Credentials:MSSA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2810
Mailing Address - Country:US
Mailing Address - Phone:616-942-7294
Mailing Address - Fax:617-942-9548
Practice Address - Street 1:3300 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512
Practice Address - Country:US
Practice Address - Phone:616-942-7294
Practice Address - Fax:617-942-9548
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010906201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical