Provider Demographics
NPI:1669813895
Name:DYER, TAMMI J (LBSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMI
Middle Name:J
Last Name:DYER
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 TURA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-4059
Mailing Address - Country:US
Mailing Address - Phone:218-779-3366
Mailing Address - Fax:
Practice Address - Street 1:9711 TURA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-4059
Practice Address - Country:US
Practice Address - Phone:218-779-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57213171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX525120Medicare UPIN