Provider Demographics
NPI:1689087637
Name:CARTER-JENSON, TAMMIE S L (EDD)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:S L
Last Name:CARTER-JENSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HEATHER MIST LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4227
Mailing Address - Country:US
Mailing Address - Phone:702-204-6151
Mailing Address - Fax:
Practice Address - Street 1:6100 HEATHER MIST LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4227
Practice Address - Country:US
Practice Address - Phone:702-204-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral