Provider Demographics
NPI:1891231692
Name:MCFADDEN, TAMMY (LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7037
Mailing Address - Country:US
Mailing Address - Phone:480-659-8245
Mailing Address - Fax:480-471-8186
Practice Address - Street 1:4450 S RURAL RD
Practice Address - Street 2:SUITE E-125
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7037
Practice Address - Country:US
Practice Address - Phone:480-659-8245
Practice Address - Fax:480-471-8186
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11856101YA0400X
AZLPC-13296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty