1588757595 NPI number — MS. TAMARA LEIGH ANDREW MS, LPC

Table of content: MS. TAMARA LEIGH ANDREW MS, LPC (NPI 1588757595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588757595 NPI number — MS. TAMARA LEIGH ANDREW MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREW
Provider First Name:
TAMARA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
TAMARA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588757595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2526
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64803-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-347-7580
Provider Business Mailing Address Fax Number:
417-347-7629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
471-347-7580
Provider Business Practice Location Address Fax Number:
471-347-7582
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2004012498 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 498774413 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com