Provider Demographics
NPI:1629607841
Name:MATTE, TAMMY (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MATTE
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BUNGALOW CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8166
Mailing Address - Country:US
Mailing Address - Phone:337-351-5730
Mailing Address - Fax:
Practice Address - Street 1:143 RIDGEWAY DR STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3414
Practice Address - Country:US
Practice Address - Phone:337-284-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional