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1700024452 NPI number — TAMMY LEE EDMONDS MA LPC NCC CCTP

NPI Number: 1700024452
Health Care Provider/Practitioner: TAMMY LEE EDMONDS MA LPC NCC CCTP

Information about “1700024452” NPI (TAMMY LEE EDMONDS MA LPC NCC CCTP) exists in 1700024452 in HTML format HTML  |  1700024452 in plain Text format TXT  |  1700024452 in PDF (Portable Document Format) PDF  |  1700024452 in an XML format XML  formats.

NPI Number : 1700024452 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700024452",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDMONDS",
    "FirstName": "TAMMY",
    "MiddleName": "LEE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MA LPC NCC CCTP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCPHERSON",
    "OtherFirstName": "TAMMY",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MA LPC NCC CCTP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "P.O. BOX 142",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BAD AXE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48413",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-269-5180",
    "MailingAddressFaxNumber": "989-623-0398",
    "FirstLinePracticeLocationAddress": "128 W HURON AVE STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BAD AXE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48413-1177",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-269-5180",
    "PracticeLocationAddressFaxNumber": "989-623-0398",
    "EnumerationDate": "02/02/2009",
    "LastUpdateDate": "08/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "L 1121008",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "6401006872",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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