MEDICARE: MRS. TAMARA MIE HAMMOURI

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639483886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA MIE HAMMOURI

Provider Business Mailing Address
First Line	:	3450 N HUALAPAI WAY UNIT 1053
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8057
Country	:	US
Telephone Number	:	808-347-4590
Fax Number	:	702-749-8124

Provider Business Practice Location Address
First Line	:	5130 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1248
Country	:	US
Telephone Number	:	702-823-3883
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	11/09/2012

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