MEDICARE: TAMARA MARIE ALLEN MA, LMFT

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	106H00000X	Marriage & Family Therapist	0717001586	VA

General Provider Information

NPI Number	:	1316583651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA MARIE ALLEN MA, LMFT

Provider Business Mailing Address
First Line	:	5226 INDIAN RIVER RD STE 100
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23464-6179
Country	:	US
Telephone Number	:	757-943-9555
Fax Number	:	757-664-9494

Provider Business Practice Location Address
First Line	:	5226 INDIAN RIVER RD STE 100
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23464-6179
Country	:	US
Telephone Number	:	757-943-9555
Fax Number	:

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

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	07/06/2020

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