MEDICARE: MS. TAMARA JORDANNA PHILLIPS LMFT

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	106H00000X	Marriage & Family Therapist	MT4799	FL

General Provider Information

NPI Number	:	1861239576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA JORDANNA PHILLIPS LMFT

Provider Business Mailing Address
First Line	:	2612 UNIVERSITY ACRES DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-3024
Country	:	US
Telephone Number	:	407-448-0727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 UNIVERSITY ACRES DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-3024
Country	:	US
Telephone Number	:	407-448-0727
Fax Number	:

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

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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