Provider Demographics
NPI:1366121915
Name:DAIGLE, TAMI S (MED, PLPC)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:S
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HUBER PARK CT STE 103
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8683
Mailing Address - Country:US
Mailing Address - Phone:636-299-0797
Mailing Address - Fax:
Practice Address - Street 1:500 HUBER PARK CT STE 103
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8683
Practice Address - Country:US
Practice Address - Phone:636-299-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023023871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health