Provider Demographics
NPI:1942368261
Name:AMMERMAN, TAMMARA A (LH 60475087)
Entity type:Individual
Prefix:
First Name:TAMMARA
Middle Name:A
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:LH 60475087
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1337
Mailing Address - Country:US
Mailing Address - Phone:360-993-3000
Mailing Address - Fax:360-993-3047
Practice Address - Street 1:13505 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2711
Practice Address - Country:US
Practice Address - Phone:360-433-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00051713101Y00000X
WALH60475087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor