Provider Demographics
NPI:1851442495
Name:ROTH, TAMMY MICHELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:ROTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4617
Mailing Address - Country:US
Mailing Address - Phone:615-218-1967
Mailing Address - Fax:
Practice Address - Street 1:4906 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4617
Practice Address - Country:US
Practice Address - Phone:615-218-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional