Provider Demographics
NPI:1578337127
Name:WHITE, TAMARA (MSW, LAC, SWLC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, LAC, SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 PARENT ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1472
Mailing Address - Country:US
Mailing Address - Phone:406-241-0059
Mailing Address - Fax:
Practice Address - Street 1:4704 PARENT ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1472
Practice Address - Country:US
Practice Address - Phone:406-241-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT64933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)