MEDICARE: MRS. TAMARA BATRICE CLESTINE VANG CRADC, MARS, LAC

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	01954	KS
2	174400000X	Specialist	15342	MO
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	15228	MO

General Provider Information

NPI Number	:	1588416002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA BATRICE CLESTINE VANG CRADC, MARS, LAC

Provider Business Mailing Address
First Line	:	10808 CLEVELAND AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-3659
Country	:	US
Telephone Number	:	816-739-9313
Fax Number	:

Provider Business Practice Location Address
First Line	:	9824 CHERRY ST APT 5
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4129
Country	:	US
Telephone Number	:	816-419-8332
Fax Number	:

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

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	06/23/2025

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