Provider Demographics
NPI:1922177641
Name:LAMUN, TABATHA LEE
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:LEE
Last Name:LAMUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4239
Mailing Address - Country:US
Mailing Address - Phone:208-316-8177
Mailing Address - Fax:
Practice Address - Street 1:8326 MAIN ST BLDG 3
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-4871
Practice Address - Country:US
Practice Address - Phone:985-868-2620
Practice Address - Fax:985-868-8547
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8114101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator