MEDICARE: MRS. TAMARA LYNN TABOR-GLANCY M.ED., CRC, LPC

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	101YP2500X	Professional Counselor	C.007903	OH
2	171M00000X	Case Manager/Care Coordinator	00047987 CRC	OH

General Provider Information

NPI Number	:	1093917189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA LYNN TABOR-GLANCY M.ED., CRC, LPC

Provider Business Mailing Address
First Line	:	1180 SALT SPRINGS RD
Second Line	:
City	:	MINERAL RIDGE
State	:	OH
Zip	:	44440-9318
Country	:	US
Telephone Number	:	330-544-0490
Fax Number	:	330-544-1196

Provider Business Practice Location Address
First Line	:	1180 SALT SPRINGS RD
Second Line	:
City	:	MINERAL RIDGE
State	:	OH
Zip	:	44440-9318
Country	:	US
Telephone Number	:	330-544-0490
Fax Number	:	330-544-1196

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	09/23/2025

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