Healthcare Provider Details

I. General information

NPI: 1508049339
Provider Name (Legal Business Name): TAMARA DAWN ALLEN BUSH LPC-S, CSAT-S, ICGC1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA DAWN ALLEN-WOLF LPCC, NCC

II. Dates (important events)

Enumeration Date: 12/15/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E FERNHURST DR STE 703
KATY TX
77450-1587
US

IV. Provider business mailing address

222 MOODY ST UNIT 495
SEALY TX
77474-4615
US

V. Phone/Fax

Practice location:
  • Phone: 817-713-7223
  • Fax: 817-887-3814
Mailing address:
  • Phone: 817-713-7223
  • Fax: 817-887-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15194
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15194
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0091041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: