Provider Demographics
NPI:1427689132
Name:AGIMUDIE, TAMARA LEE MICHELLE (LPC-I)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE MICHELLE
Last Name:AGIMUDIE
Suffix:
Gender:F
Credentials:LPC-I
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 5857
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5857
Mailing Address - Country:US
Mailing Address - Phone:832-233-3086
Mailing Address - Fax:832-201-8229
Practice Address - Street 1:2323 TIMBER SHADOWS DR STE B
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2028
Practice Address - Country:US
Practice Address - Phone:832-233-3086
Practice Address - Fax:832-201-8229
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX78373OtherTEXAS STATE BOARD