Provider Demographics
NPI:1750616124
Name:WHITE, TAMILYN D (LPC, NCC)
Entity type:Individual
Prefix:
First Name:TAMILYN
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:TAMILYN
Other - Middle Name:D
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:15954 RIVERS EDGE
Mailing Address - Street 2:15954 RIVERS EDGE DRIVE
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843
Mailing Address - Country:US
Mailing Address - Phone:715-634-2541
Mailing Address - Fax:715-934-5090
Practice Address - Street 1:NORTHLAKES COMMUNITY CLINIC
Practice Address - Street 2:15954 RIVERS EDGE DRIVE
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5484
Practice Address - Country:US
Practice Address - Phone:715-634-2541
Practice Address - Fax:715-934-5090
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4727-125101YP2500X
WI4272-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional