Healthcare Provider Details

I. General information

NPI: 1063033132
Provider Name (Legal Business Name): TAMORRA MUNCY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 PARKERS MILL WAY
SOMERSET KY
42503-4152
US

IV. Provider business mailing address

87 BRUCE LN
CORBIN KY
40701-4900
US

V. Phone/Fax

Practice location:
  • Phone: 606-594-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number290301
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number290995
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: