Provider Demographics
NPI:1043649700
Name:PREVOST, TAMALA EDWARDS (LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMALA
Middle Name:EDWARDS
Last Name:PREVOST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2909
Mailing Address - Country:US
Mailing Address - Phone:985-969-9194
Mailing Address - Fax:
Practice Address - Street 1:3109 ALLEN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:985-969-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1463101YA0400X
LA5319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)