Provider Demographics
NPI:1063707131
Name:WOODYARD-POWELL, TAMMY L (PCC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:WOODYARD-POWELL
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 DAVON CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6927
Mailing Address - Country:US
Mailing Address - Phone:513-300-8219
Mailing Address - Fax:
Practice Address - Street 1:714 EATON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-4602
Practice Address - Country:US
Practice Address - Phone:513-887-5170
Practice Address - Fax:513-887-5186
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-1000046101YM0800X
OHE.1000046-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health