Provider Demographics
NPI:1942957352
Name:DAVIS, TAMMY MICHELLE (MPH, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MPH, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 LONGMIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5424
Mailing Address - Country:US
Mailing Address - Phone:979-777-1683
Mailing Address - Fax:979-704-5140
Practice Address - Street 1:2748 LONGMIRE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5424
Practice Address - Country:US
Practice Address - Phone:979-777-1683
Practice Address - Fax:979-704-5140
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty