Provider Demographics
NPI:1841640893
Name:MCKINDRA, TAMIKA NICOLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:NICOLE
Last Name:MCKINDRA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 COBALT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-1303
Mailing Address - Country:US
Mailing Address - Phone:469-260-4122
Mailing Address - Fax:
Practice Address - Street 1:1106 SANTA FE TRL
Practice Address - Street 2:STE 9
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3063
Practice Address - Country:US
Practice Address - Phone:469-260-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72002101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health