Provider Demographics
NPI:1407603582
Name:BENJAMIN, TAMMY ELAINE (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ELAINE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24014 SPRING OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8937
Mailing Address - Country:US
Mailing Address - Phone:281-739-2671
Mailing Address - Fax:
Practice Address - Street 1:24014 SPRING OAK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8937
Practice Address - Country:US
Practice Address - Phone:281-739-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator