Provider Demographics
NPI:1063776037
Name:MATTINGLY, TAMMY LYNN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 SAM BROWNING RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-9114
Mailing Address - Country:US
Mailing Address - Phone:270-402-5601
Mailing Address - Fax:
Practice Address - Street 1:2894 SAM BROWNING RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-9114
Practice Address - Country:US
Practice Address - Phone:270-402-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor