Healthcare Provider Details

I. General information

NPI: 1467684761
Provider Name (Legal Business Name): TAMMY OBIE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 COUNTY ROAD 9 S
ALAMOSA CO
81101-9610
US

IV. Provider business mailing address

8745 COUNTY ROAD 9 S
ALAMOSA CO
81101-9610
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-3671
  • Fax: 719-589-9136
Mailing address:
  • Phone: 719-589-3671
  • Fax: 719-589-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: