Healthcare Provider Details

I. General information

NPI: 1508052564
Provider Name (Legal Business Name): TAMARA LEININGER LPC-MHSP-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA EADE LPCC, NCC

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 WILMA RUDOLPH BLVD UNIT 30143
CLARKSVILLE TN
37040-0105
US

IV. Provider business mailing address

2031 WILMA RUDOLPH BLVD UNIT 30143
CLARKSVILLE TN
37040-0105
US

V. Phone/Fax

Practice location:
  • Phone: 931-358-8114
  • Fax:
Mailing address:
  • Phone: 931-358-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4080
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104281
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: