1265506190 NPI number — TAMMY STAR LMHC

Table of content: TAMMY STAR LMHC (NPI 1265506190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265506190 NPI number — TAMMY STAR LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAR
Provider First Name:
TAMMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265506190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 SHORT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-5712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-223-8003
Provider Business Mailing Address Fax Number:
321-452-2802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 N WICKHAM RD STE 12-224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIERA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-7976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-223-8003
Provider Business Practice Location Address Fax Number:
321-452-2802
Provider Enumeration Date:
11/20/2006

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: 101YM0800X , with the licence number:  MH7949 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008070200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205636867 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 811814100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z117J . This is a "BCBSF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 811814100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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