Provider Demographics
NPI:1205159480
Name:HOLLEMAN, TAMMY MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:HOLLEMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12516 VERANDAH CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4602
Mailing Address - Country:US
Mailing Address - Phone:512-517-0272
Mailing Address - Fax:
Practice Address - Street 1:4107 MEDICAL PKWY
Practice Address - Street 2:209
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3735
Practice Address - Country:US
Practice Address - Phone:512-323-2292
Practice Address - Fax:866-848-9016
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX500571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical