MEDICARE: MS. TAMARA DENISE PENA LCDC, LPC-S, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	67578	TX
2	101YM0800X	Mental Health Counselor	67578	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	14131	TX
4	101YP2500X	Professional Counselor	67578	TX

General Provider Information

NPI Number	:	1023357043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA DENISE PENA LCDC, LPC-S, NCC

Provider Business Mailing Address
First Line	:	3003 S LOOP W STE 410B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1383
Country	:	US
Telephone Number	:	832-203-5987
Fax Number	:	832-203-4086

Provider Business Practice Location Address
First Line	:	3003 S LOOP W STE 410B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1383
Country	:	US
Telephone Number	:	832-203-5987
Fax Number	:	832-203-4086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	12/08/2025

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