Provider Demographics
NPI:1558452888
Name:AMICONE, TAMALA A (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMALA
Middle Name:A
Last Name:AMICONE
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 WYNTREE CV
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-8998
Mailing Address - Country:US
Mailing Address - Phone:662-253-5170
Mailing Address - Fax:
Practice Address - Street 1:REGION III MENTAL HEALTH CENTER
Practice Address - Street 2:2434 SOUTH EASON BLVD
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6942
Practice Address - Country:US
Practice Address - Phone:662-844-1717
Practice Address - Fax:662-680-6416
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional