Provider Demographics
NPI:1184990780
Name:HARTLEY, TAMARA A (LPC CSAC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LPC CSAC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:ALEXANDRA
Other - Last Name:TRUSEWYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1216 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2515
Mailing Address - Country:US
Mailing Address - Phone:414-316-2003
Mailing Address - Fax:
Practice Address - Street 1:1216 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2515
Practice Address - Country:US
Practice Address - Phone:414-316-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16038-132101YA0400X
WI6678-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)