MEDICARE: TAMMY LYNN BOTELLO LPC

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	101YP2500X	Professional Counselor	19232	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043340615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY LYNN BOTELLO LPC

Provider Business Mailing Address
First Line	:	1122 W PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	817-538-5998
Fax Number	:	817-549-7139

Provider Business Practice Location Address
First Line	:	1122 W PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	817-538-5998
Fax Number	:	817-549-7139

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	10/14/2021

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