Healthcare Provider Details

I. General information

NPI: 1467782680
Provider Name (Legal Business Name): TAMMY L ROME LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 520-319-6188
  • Fax: 520-645-2685
Mailing address:
  • Phone: 520-840-5482
  • Fax: 520-645-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number115058
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13244075-6004
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20993
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number08224
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: