MEDICARE: MS. TAMMY L ROME 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	20993	AZ
2	101YP2500X	Professional Counselor	08224	KS
3	101YM0800X	Mental Health Counselor	115058	IA
4	101YM0800X	Mental Health Counselor	13244075-6004	UT

General Provider Information

NPI Number	:	1467782680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY L ROME LPC

Provider Business Mailing Address
First Line	:	4539 N 22ND ST STE R
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	520-840-5482
Fax Number	:	520-645-2685

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST STE R
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	520-319-6188
Fax Number	:	520-645-2685

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

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/14/2026

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