Provider Demographics
NPI:1972946283
Name:EWERT, TAMARA DIANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:DIANE
Last Name:EWERT
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 1:2216 WASHBURN WAY
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5749
Mailing Address - Country:US
Mailing Address - Phone:318-518-0487
Mailing Address - Fax:
Practice Address - Street 1:2216 WASHBURN WAY
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5749
Practice Address - Country:US
Practice Address - Phone:318-518-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health