Provider Demographics
NPI:1578633160
Name:LIAS, TAMMY RAE (LMFT, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RAE
Last Name:LIAS
Suffix:
Gender:F
Credentials:LMFT, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47558 254TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:SD
Mailing Address - Zip Code:57003-5930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47558 254TH ST
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:SD
Practice Address - Zip Code:57003-5930
Practice Address - Country:US
Practice Address - Phone:605-351-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT1192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist