Healthcare Provider Details

I. General information

NPI: 1407333735
Provider Name (Legal Business Name): TAMMY PLATER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 FAIRFIELD AVE STE 1A
SHREVEPORT LA
71104-2066
US

IV. Provider business mailing address

2015 FAIRFIELD AVE STE 1A
SHREVEPORT LA
71104-2066
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-0406
  • Fax: 318-675-0408
Mailing address:
  • Phone: 318-675-0406
  • Fax: 318-675-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC9007
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: