Provider Demographics
NPI:1699138628
Name:GIVENS, TAMARA (LPCC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 FREESTONE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2791
Mailing Address - Country:US
Mailing Address - Phone:502-644-4101
Mailing Address - Fax:
Practice Address - Street 1:930 MARY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2425
Practice Address - Country:US
Practice Address - Phone:502-690-4286
Practice Address - Fax:855-644-3659
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100689640Medicaid