Provider Demographics
NPI:1740501287
Name:HALL, TAMRA KAY (PHD, LPC, LMHC, CCS)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:KAY
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, LPC, LMHC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 EASTERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-2406
Mailing Address - Country:US
Mailing Address - Phone:616-855-6402
Mailing Address - Fax:
Practice Address - Street 1:3417 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-2406
Practice Address - Country:US
Practice Address - Phone:616-855-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010124101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional