Provider Demographics
NPI:1255056453
Name:LANDRUM, TAMELA ALISHA
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:ALISHA
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 JACOBS WAY
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-7899
Mailing Address - Country:US
Mailing Address - Phone:850-982-6851
Mailing Address - Fax:
Practice Address - Street 1:3250 W NAVY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-8065
Practice Address - Country:US
Practice Address - Phone:850-450-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health