Provider Demographics
NPI:1144937749
Name:STANLEY, TAMIKO LYNNE
Entity type:Individual
Prefix:
First Name:TAMIKO
Middle Name:LYNNE
Last Name:STANLEY
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 1:8226 DOUGLAS AVE STE 805
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5930
Mailing Address - Country:US
Mailing Address - Phone:972-689-8859
Mailing Address - Fax:214-373-3404
Practice Address - Street 1:8226 DOUGLAS AVE STE 805
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5930
Practice Address - Country:US
Practice Address - Phone:972-689-8859
Practice Address - Fax:214-373-3404
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 104100000X
TX104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health