Provider Demographics
NPI:1891088506
Name:BRANDON, TAMMI L (MC, NCC, LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:L
Last Name:BRANDON
Suffix:
Gender:F
Credentials:MC, NCC, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 W NORTH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1222
Mailing Address - Country:US
Mailing Address - Phone:602-430-1882
Mailing Address - Fax:
Practice Address - Street 1:13460 N 94TH DR
Practice Address - Street 2:K-3
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4835
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:623-974-3390
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11695101YA0400X
AZLPC-12381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)