Provider Demographics
NPI:1689208647
Name:MILLIKEN, TAMMIE LYNNE (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYNNE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N CAMPBELL AVE
Mailing Address - Street 2:STE 13
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2357
Mailing Address - Country:US
Mailing Address - Phone:520-975-3017
Mailing Address - Fax:
Practice Address - Street 1:3333 N CAMPBELL AVE
Practice Address - Street 2:STE 13
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2357
Practice Address - Country:US
Practice Address - Phone:520-261-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-18803OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS