Provider Demographics
NPI:1386505048
Name:TAILGATE TIME INC
Entity type:Organization
Organization Name:TAILGATE TIME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:901-832-3050
Mailing Address - Street 1:778 COUNTY ROAD 680
Mailing Address - Street 2:
Mailing Address - City:BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72411-9300
Mailing Address - Country:US
Mailing Address - Phone:901-832-3050
Mailing Address - Fax:
Practice Address - Street 1:778 COUNTY ROAD 680
Practice Address - Street 2:
Practice Address - City:BAY
Practice Address - State:AR
Practice Address - Zip Code:72411-9300
Practice Address - Country:US
Practice Address - Phone:901-832-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty