Provider Demographics
NPI:1972309748
Name:KING, TAMMY L (LCSW)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:KING
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 PEARSON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77517-3284
Mailing Address - Country:US
Mailing Address - Phone:409-370-8871
Mailing Address - Fax:
Practice Address - Street 1:6219 PEARSON RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77517-3284
Practice Address - Country:US
Practice Address - Phone:409-370-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty