Provider Demographics
NPI:1629387329
Name:AVERY, TAMARA (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S DIXON ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4719
Mailing Address - Country:US
Mailing Address - Phone:940-612-2445
Mailing Address - Fax:940-503-2553
Practice Address - Street 1:208 S DIXON ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4719
Practice Address - Country:US
Practice Address - Phone:817-908-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34617103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical