Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | TX | |
N | 101YM0800X | Mental Health Counselor | TX | |
N | 101YP1600X | Pastoral Counselor | TX | |
Y | 102L00000X | Psychologist | TX | |
Y | 103T00000X | Psychologist | TX |
NPI | 1114477403 |
---|---|
Provider Name | Tammi Evans Witherspoon |
First Address | Arlington, TX 76013-7604 |
Second Address | Arlington, TX 76013-7604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2016 |
Last Update Date | 14/10/2016 |