Provider Demographics
NPI:1700024452
Name:EDMONDS, TAMMY LEE (MA LPC NCC CCTP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LEE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MA LPC NCC CCTP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LEE
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC NCC CCTP
Mailing Address - Street 1:P.O. BOX 142
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:810-334-3631
Mailing Address - Fax:989-269-5185
Practice Address - Street 1:128 W. HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:810-334-3631
Practice Address - Fax:989-269-5185
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006872101YP2500X
MIL 1121008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional