Provider Demographics
NPI:1699588517
Name:TAVARES, ANN MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:TAVARES
Suffix:
Gender:U
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E THARPE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5550
Mailing Address - Country:US
Mailing Address - Phone:448-500-4489
Mailing Address - Fax:
Practice Address - Street 1:215 E THARPE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5550
Practice Address - Country:US
Practice Address - Phone:850-448-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty