Provider Demographics
NPI:1194349118
Name:HOLMSTROM, TAMMY M (BS, CADC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:HOLMSTROM
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FAIR MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-3209
Mailing Address - Country:US
Mailing Address - Phone:515-832-5432
Mailing Address - Fax:
Practice Address - Street 1:500 FAIR MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-3209
Practice Address - Country:US
Practice Address - Phone:515-832-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20031101YA0400X
IA124689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)