Provider Demographics
NPI:1558869172
Name:LETBETTER, TAMMARRA (MED, LPC)
Entity Type:Individual
Prefix:
First Name:TAMMARRA
Middle Name:
Last Name:LETBETTER
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 1:5369 LAS COLINAS BLVD APT 2406
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4486
Mailing Address - Country:US
Mailing Address - Phone:678-502-8375
Mailing Address - Fax:
Practice Address - Street 1:1636 N HAMPTON RD STE 101
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8600
Practice Address - Country:US
Practice Address - Phone:469-242-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74816101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)