Provider Demographics
NPI:1841164639
Name:MOMAN, TAMELA
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:
Last Name:MOMAN
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:PO BOX 14131
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-4131
Mailing Address - Country:US
Mailing Address - Phone:769-300-5340
Mailing Address - Fax:
Practice Address - Street 1:1501 JACKSONIAN PLZ STE 14131
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5454
Practice Address - Country:US
Practice Address - Phone:769-300-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management