Provider Demographics
NPI:1801129416
Name:WHITE, TAMMY L (LMSW)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 W. HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020
Mailing Address - Country:US
Mailing Address - Phone:505-285-5451
Mailing Address - Fax:505-285-6436
Practice Address - Street 1:2595 WEST HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020
Practice Address - Country:US
Practice Address - Phone:505-285-5451
Practice Address - Fax:505-285-6436
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-083191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16351720Medicaid