Provider Demographics
NPI:1619150042
Name:BARBOSA, TAMRA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:JEAN
Last Name:BARBOSA
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 1:4191 CRESCENT DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1000
Mailing Address - Country:US
Mailing Address - Phone:314-892-5995
Mailing Address - Fax:314-892-5996
Practice Address - Street 1:4191 CRESCENT DR
Practice Address - Street 2:SUITE D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1000
Practice Address - Country:US
Practice Address - Phone:314-892-5995
Practice Address - Fax:314-892-5996
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002020618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002020618OtherLICENSE NUMBER