Provider Demographics
NPI:1962999177
Name:MYATT, TAMMRA RASHELLE
Entity type:Individual
Prefix:
First Name:TAMMRA
Middle Name:RASHELLE
Last Name:MYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 RIVER LODGE TRL S APT 536
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0836
Mailing Address - Country:US
Mailing Address - Phone:817-319-6429
Mailing Address - Fax:
Practice Address - Street 1:161 JD TOWLES DR
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8654
Practice Address - Country:US
Practice Address - Phone:682-900-1444
Practice Address - Fax:682-900-1444
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4270106E00000X
TXRBT-17-28060106S00000X
TX5795103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician