Provider Demographics
NPI:1740501287
Name:HALL, TAMRA KAY (PHD, LPC, LMHC, CCS)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:KAY
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, LPC, LMHC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11958 CYPRESS LINKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8402
Mailing Address - Country:US
Mailing Address - Phone:269-830-2110
Mailing Address - Fax:
Practice Address - Street 1:11958 CYPRESS LINKS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8402
Practice Address - Country:US
Practice Address - Phone:269-830-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600084101YA0400X, 101YP2500X
MIC-02619101YA0400X
216934101YM0800X
MI6401010124101YP2500X
MIS-201471041C0700X
FLMH12744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical