Provider Demographics
NPI:1619531688
Name:DAVIDSON, TAMARA JO (LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:JO
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:7630 MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1941
Mailing Address - Country:US
Mailing Address - Phone:816-405-5434
Mailing Address - Fax:
Practice Address - Street 1:7630 MCGEE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1941
Practice Address - Country:US
Practice Address - Phone:816-405-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014044168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional