Healthcare Provider Details

I. General information

NPI: 1376385336
Provider Name (Legal Business Name): TAMMY FRERICH PARRISH LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S ELLIS ST.
MENARD TX
76859-0889
US

IV. Provider business mailing address

PO BOX 669
MENARD TX
76859-0669
US

V. Phone/Fax

Practice location:
  • Phone: 325-396-4612
  • Fax: 325-396-2055
Mailing address:
  • Phone: 325-869-5500
  • Fax: 855-634-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93679
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: