Provider Demographics
NPI:1760049720
Name:BEABER, TAMARA LEIGH (LSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEIGH
Last Name:BEABER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N TERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1343
Mailing Address - Country:US
Mailing Address - Phone:815-878-8981
Mailing Address - Fax:
Practice Address - Street 1:629 N TERRY ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1343
Practice Address - Country:US
Practice Address - Phone:815-878-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker