Provider Demographics
NPI:1629497128
Name:TSAMOUTALES, LORILEE
Entity Type:Individual
Prefix:
First Name:LORILEE
Middle Name:
Last Name:TSAMOUTALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7607
Mailing Address - Country:US
Mailing Address - Phone:321-795-9324
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:3075 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7607
Practice Address - Country:US
Practice Address - Phone:321-795-9324
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other