MEDICARE: MRS. TAMI OOMMEN LMHC

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	MH10830	FL
2	101YM0800X	Mental Health Counselor	MH10830	FL
3	101YP2500X	Professional Counselor	MH10830	FL

General Provider Information

NPI Number	:	1598139354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMI OOMMEN LMHC

Provider Business Mailing Address
First Line	:	2310 SE 2ND ST
Second Line	:	SUITE 7
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7280
Country	:	US
Telephone Number	:	561-336-2162
Fax Number	:	561-336-2258

Provider Business Practice Location Address
First Line	:	2310 SE 2ND ST
Second Line	:	SUITE 7
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7280
Country	:	US
Telephone Number	:	561-336-2162
Fax Number	:	561-336-2258

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

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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