Provider Demographics
NPI:1114477403
Name:WITHERSPOON, TAMMI EVANS
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:EVANS
Last Name:WITHERSPOON
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 1:1119 W PIONEER PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7604
Mailing Address - Country:US
Mailing Address - Phone:682-238-3831
Mailing Address - Fax:817-274-1900
Practice Address - Street 1:1119 W PIONEER PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7604
Practice Address - Country:US
Practice Address - Phone:682-238-3831
Practice Address - Fax:817-274-1900
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX101YA0400X, 101YM0800X, 101YP1600X, 103T00000X, 106H00000X, 320800000X, 320900000X, 320600000X, 324500000X, 322D00000X, 273R00000X, 282J00000X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No273R00000XHospital UnitsPsychiatric Unit
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No284300000XHospitalsSpecial Hospital