Healthcare Provider Details

I. General information

NPI: 1417189770
Provider Name (Legal Business Name): TAMMY LYNN BEAM M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 NEW LA GRANGE RD SUITE 7
LOUISVILLE KY
40222-4767
US

IV. Provider business mailing address

7980 NEW LA GRANGE RD SUITE 7
LOUISVILLE KY
40222-4767
US

V. Phone/Fax

Practice location:
  • Phone: 502-386-9731
  • Fax: 502-412-9204
Mailing address:
  • Phone: 502-386-9731
  • Fax: 502-412-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberKY-0885
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: