Provider Demographics
NPI:1417995572
Name:TUBRE, TAMMY RENEE (LPC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENEE
Last Name:TUBRE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WOODSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270
Mailing Address - Country:US
Mailing Address - Phone:318-202-5326
Mailing Address - Fax:
Practice Address - Street 1:203 S VIENNA ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4442
Practice Address - Country:US
Practice Address - Phone:318-254-1234
Practice Address - Fax:318-254-1235
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2003101YP2500X
101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA#2003OtherSTATE OF LOUISIANA