Healthcare Provider Details

I. General information

NPI: 1225311137
Provider Name (Legal Business Name): TAMARA J CARTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 INDUSTRIAL DR
OWOSSO MI
48867-9775
US

IV. Provider business mailing address

1555 INDUSTRIAL DR
OWOSSO MI
48867-9775
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-6791
  • Fax: 989-725-5061
Mailing address:
  • Phone: 989-213-4430
  • Fax: 989-725-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: