MEDICARE: MS. TAMMY LYNN HOGAN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	13988	TX
2	101YP2500X	Professional Counselor	95253	TX

General Provider Information

NPI Number	:	1154806529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY LYNN HOGAN

Provider Business Mailing Address
First Line	:	4702 N LAURENT ST STE D
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2158
Country	:	US
Telephone Number	:	361-572-0202
Fax Number	:	361-572-0300

Provider Business Practice Location Address
First Line	:	4702 N. LAURENT STE D
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904
Country	:	US
Telephone Number	:	361-572-0202
Fax Number	:	361-572-0300

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

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	06/09/2026

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