MEDICARE: TANYA TAMKIO GRAVES 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	101Y00000X	Counselor	C2992A	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2992A	OTHER	AL	ALABAMA BOARD OF EXAMINERS IN COUNSELING

General Provider Information

NPI Number	:	1518436427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA TAMKIO GRAVES LPC

Provider Business Mailing Address
First Line	:	1373 BARRET PARK WAY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-9248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 HAMPSTEAD HIGH ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-6788
Country	:	US
Telephone Number	:	334-647-1047
Fax Number	:

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

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	01/07/2026

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