MEDICARE: TAMYRA NIKITA WARE LAWSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	56316	TX

General Provider Information

NPI Number	:	1023616703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMYRA NIKITA WARE LAWSON LCSW

Provider Business Mailing Address
First Line	:	4000 S INDIGO DR
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5017
Country	:	US
Telephone Number	:	832-998-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 TOWN AND COUNTRY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-4164
Country	:	US
Telephone Number	:	832-998-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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