Provider Demographics
NPI:1588416002
Name:VANG, TAMARA BATRICE CLESTINE (CRADC, MARS, LAC)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:BATRICE CLESTINE
Last Name:VANG
Suffix:
Gender:
Credentials:CRADC, MARS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 N 103RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-5815
Mailing Address - Country:US
Mailing Address - Phone:816-739-9313
Mailing Address - Fax:
Practice Address - Street 1:300 E 39TH ST STE 5C
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1531
Practice Address - Country:US
Practice Address - Phone:816-934-1344
Practice Address - Fax:816-934-1344
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15228101YA0400X
MO15342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist