Provider Demographics
NPI:1700856424
Name:HAMNER, TAMMY MORGAN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MORGAN
Last Name:HAMNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W MAIN ST
Mailing Address - Street 2:HARRON SQUARE, SUITE 203
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1650
Mailing Address - Country:US
Mailing Address - Phone:304-842-7007
Mailing Address - Fax:304-842-7099
Practice Address - Street 1:917 W MAIN ST
Practice Address - Street 2:HARRON SQUARE, SUITE 203
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1650
Practice Address - Country:US
Practice Address - Phone:304-842-7007
Practice Address - Fax:304-842-7099
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9204026000Medicaid
WV9204026000Medicaid