=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285432914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMMY MATTE LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2025
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 S COLLEGE RD STE 211
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-3062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-351-5730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 BUNGALOW CT
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-8166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 133-735-1573
-----------------------------------------------------
Fax | 133-735-1573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | TAMMY MATTE
-----------------------------------------------------
Credential | MA, LPC, RPT
-----------------------------------------------------
Telephone | 337-351-5730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------