Provider Demographics
NPI:1134259476
Name:HODGES, TAMARA LYNN (EDD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:HODGES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LONDONDERRY
Mailing Address - Street 2:STE 7
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7906
Mailing Address - Country:US
Mailing Address - Phone:254-776-7792
Mailing Address - Fax:254-776-0577
Practice Address - Street 1:305 LONDONDERRY
Practice Address - Street 2:STE 7
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7906
Practice Address - Country:US
Practice Address - Phone:254-776-7792
Practice Address - Fax:254-776-0577
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5171103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist