Provider Demographics
NPI:1568696375
Name:DURHAM, TARNICIA R (LPC)
Entity Type:Individual
Prefix:MS
First Name:TARNICIA
Middle Name:R
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 EMMET HUTTO BLVD APT 1105
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1793
Mailing Address - Country:US
Mailing Address - Phone:601-214-1163
Mailing Address - Fax:
Practice Address - Street 1:505 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE 502
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4018
Practice Address - Country:US
Practice Address - Phone:281-447-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX67426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health