Provider Demographics
NPI:1639634686
Name:GUILLORY, TAMMY LEDET (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEDET
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6377
Mailing Address - Country:US
Mailing Address - Phone:337-240-8454
Mailing Address - Fax:
Practice Address - Street 1:1323 12TH ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6377
Practice Address - Country:US
Practice Address - Phone:337-240-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL4405410021744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1744P3200XOtherCERTIFIED HAIR LOSS SPECIALIST