Provider Demographics
NPI:1851768295
Name:HANCOOK, TAMMY LEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEE
Last Name:HANCOOK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:LEE
Other - Last Name:KOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-337-6545
Mailing Address - Fax:517-337-3010
Practice Address - Street 1:234 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-337-6545
Practice Address - Fax:517-337-3010
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801095309OtherMI LICENSE NUMBER