Provider Demographics
NPI:1669450755
Name:IMEL, TAMARA LEE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LEE
Last Name:IMEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-5236
Mailing Address - Country:US
Mailing Address - Phone:765-703-2720
Mailing Address - Fax:
Practice Address - Street 1:744 HAWTHORN RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-5236
Practice Address - Country:US
Practice Address - Phone:765-703-2720
Practice Address - Fax:765-703-2720
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001395A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000194594OtherBLUE CROSS ID
IN000000884714OtherANTHEM
IN000000884527OtherANTHEM
IN296837000OtherMAGELLAN HEALTH PROVIDER
IN60054OtherAETNA PROVIDER ID