Provider Demographics
NPI:1982941142
Name:LEE, TAMARA P (MS, LPC, LMFTA, NCC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:P
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, LPC, LMFTA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 BALDWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3904
Mailing Address - Country:US
Mailing Address - Phone:361-888-6041
Mailing Address - Fax:
Practice Address - Street 1:1444 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3904
Practice Address - Country:US
Practice Address - Phone:361-888-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65473101YM0800X, 101YP2500X
TX201654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist