Provider Demographics
NPI:1275123051
Name:GANT, TAMEKA LATRICE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMEKA
Middle Name:LATRICE
Last Name:GANT
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:PO BOX 342595
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38184-2595
Mailing Address - Country:US
Mailing Address - Phone:901-451-7052
Mailing Address - Fax:901-284-0011
Practice Address - Street 1:1384 CORDOVA CV STE 1
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2219
Practice Address - Country:US
Practice Address - Phone:901-451-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91842101YP2500X
TN5388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty