Provider Demographics
NPI:1992449201
Name:EMERY, TAMARA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:EMERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24002 NE TREEHILL DR
Mailing Address - Street 2:
Mailing Address - City:WOOD VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1156
Mailing Address - Country:US
Mailing Address - Phone:503-984-4552
Mailing Address - Fax:
Practice Address - Street 1:24002 NE TREEHILL DR
Practice Address - Street 2:
Practice Address - City:WOOD VILLAGE
Practice Address - State:OR
Practice Address - Zip Code:97060-1156
Practice Address - Country:US
Practice Address - Phone:503-984-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL74561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty