Healthcare Provider Details

I. General information

NPI: 1144094350
Provider Name (Legal Business Name): ANGELA TAMAYO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WILLOW BRANCH DR
JACKSON TN
38305-6624
US

IV. Provider business mailing address

435 METROPLEX DR # 201
NASHVILLE TN
37211-3109
US

V. Phone/Fax

Practice location:
  • Phone: 731-217-4602
  • Fax:
Mailing address:
  • Phone: 615-682-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9651
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12561
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: