Provider Demographics
NPI:1194762906
Name:HARRIS, TAMMI LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N COLLEGE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2012
Mailing Address - Country:US
Mailing Address - Phone:479-466-3395
Mailing Address - Fax:501-222-8981
Practice Address - Street 1:1011 N COLLEGE AVE STE 304
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-466-3395
Practice Address - Fax:501-222-8981
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1777-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X610Medicare ID - Type UnspecifiedMEDICARE PROVIDER #