Provider Demographics
NPI:1104928746
Name:PELLANT, TAMARA (MS,, LPC)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:PELLANT
Suffix:
Gender:F
Credentials:MS,, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ESSEX CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3139
Mailing Address - Country:US
Mailing Address - Phone:256-464-9755
Mailing Address - Fax:256-774-7579
Practice Address - Street 1:100 ESSEX CT
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3139
Practice Address - Country:US
Practice Address - Phone:256-464-9755
Practice Address - Fax:256-774-7579
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501383OtherAMERICAN BEHAVIORAL
VA128680OtherVALUEOPTIONS
SC128680OtherVALUEOPTIONS TRICARE
IL220940OtherCOMPSYCH
MN1045501OtherCIGNA BEHAVIORAL HEALTH
TN4035865OtherBCBS OF TENNESSEE
GA62-99825OtherUBH ALLKIDS
AL51008816OtherBCBS OF ALABAMA
NH116534OtherBEHAVIORAL HEALTH NETWORK
GA62-99825OtherUNITED BEHAVIORAL HEALTH
CT7286337OtherAETNA