Provider Demographics
NPI:1215243597
Name:CONSEJO, TAMMIE ANNE (LCMHC)
Entity type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:ANNE
Last Name:CONSEJO
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:SHELDON SPRINGS
Mailing Address - State:VT
Mailing Address - Zip Code:05485-0422
Mailing Address - Country:US
Mailing Address - Phone:802-651-8999
Mailing Address - Fax:802-651-8997
Practice Address - Street 1:595 DORSET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6240
Practice Address - Country:US
Practice Address - Phone:802-651-8999
Practice Address - Fax:802-651-8997
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008978Medicaid