Provider Demographics
NPI:1871977561
Name:SIMPSON DAVIS, TAMARA (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SIMPSON DAVIS
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 DEVILLE LN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6313
Mailing Address - Country:US
Mailing Address - Phone:318-465-1234
Mailing Address - Fax:318-868-0638
Practice Address - Street 1:904 DEVILLE LN
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6313
Practice Address - Country:US
Practice Address - Phone:318-465-1234
Practice Address - Fax:318-868-0638
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional