Provider Demographics
NPI:1750901286
Name:BARR, TAMMY J (CDCA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:BARR
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 GRAND LAKE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4594
Mailing Address - Country:US
Mailing Address - Phone:330-220-4329
Mailing Address - Fax:
Practice Address - Street 1:13377 SMITH RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7810
Practice Address - Country:US
Practice Address - Phone:440-341-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.173093101YA0400X
OHCDCA.178778101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)