Provider Demographics
NPI:1952928343
Name:ELLER, TAMI KAY (MS)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:KAY
Last Name:ELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W 79TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4316
Mailing Address - Country:US
Mailing Address - Phone:907-227-2518
Mailing Address - Fax:
Practice Address - Street 1:1709 BRAGAW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3436
Practice Address - Country:US
Practice Address - Phone:907-792-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health