Provider Demographics
NPI:1588757595
Name:ANDREW, TAMARA LEIGH (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LEIGH
Last Name:ANDREW
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:LEIGH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7580
Mailing Address - Fax:417-347-7629
Practice Address - Street 1:1800 W 30TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1520
Practice Address - Country:US
Practice Address - Phone:471-347-7580
Practice Address - Fax:471-347-7582
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498774413Medicaid