Provider Demographics
NPI:1588416002
Name:VANG, TAMARA BATRICE CLESTINE (CRADC, MARS, LAC)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:BATRICE CLESTINE
Last Name:VANG
Suffix:
Gender:F
Credentials:CRADC, MARS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10808 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-3659
Mailing Address - Country:US
Mailing Address - Phone:816-739-9313
Mailing Address - Fax:
Practice Address - Street 1:9824 CHERRY ST APT 5
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4129
Practice Address - Country:US
Practice Address - Phone:816-419-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01954101YA0400X
MO15342174400000X
MO15228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist