Provider Demographics
NPI:1689722357
Name:WERTH, TAMARA R (LCP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:R
Last Name:WERTH
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 AND A HALF MASSACHUSETTS
Mailing Address - Street 2:STE 127
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-393-4966
Mailing Address - Fax:785-865-0105
Practice Address - Street 1:719 AND A HALF MASSACHUSETTS
Practice Address - Street 2:STE 127
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-393-4966
Practice Address - Fax:785-865-0105
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS129103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
29962026OtherBCBS OF KANSAS CITY