Provider Demographics
NPI:1588178537
Name:TAMARA, JOAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:TAMARA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 UNIVERSITY AVE STE 3D
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1343
Mailing Address - Country:US
Mailing Address - Phone:515-255-1566
Mailing Address - Fax:515-506-5058
Practice Address - Street 1:12247 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8147
Practice Address - Country:US
Practice Address - Phone:515-393-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1619054335103TA0400X
IA095696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1821155284Medicaid