Provider Demographics
NPI:1558869172
Name:LETBETTER, TAMMARRA (MED, LPC)
Entity type:Individual
Prefix:
First Name:TAMMARRA
Middle Name:
Last Name:LETBETTER
Suffix:
Gender:F
Credentials:MED, 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 143621
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6535
Mailing Address - Country:US
Mailing Address - Phone:678-502-8375
Mailing Address - Fax:469-519-0616
Practice Address - Street 1:8204 ELMBROOK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4067
Practice Address - Country:US
Practice Address - Phone:469-407-1120
Practice Address - Fax:469-519-0616
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74816101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty