Individual
TAMRA WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2485 E SOUTHLAKE BLVD, SUITE 180, SOUTHLAKE, TX 76092-6686
(940) 224-0105
(817) 488-9656
Mailing address
2705 BRITTANY LN, GRAPEVINE, TX 76051-4302
(940) 224-0105
(817) 488-9656
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
16685
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123743
SUPERIOR
TX
05
—
145671701
—
TX
01
—
286692
MHN
TX
01
—
6137LC
BLUE CROSS BLUE SHIELD
TX
01
—
7856443
AETNA BEHAVIORAL HEALTH
TX
Enumeration date
07/19/2005
Last updated
11/11/2010
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