Provider Demographics
NPI:1538737119
Name:COVERT, TAMARA LYNNE (LCPC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNNE
Last Name:COVERT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:LYNNE
Other - Last Name:COVERT-SCHNABEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1703 HARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6402
Mailing Address - Country:US
Mailing Address - Phone:217-721-4657
Mailing Address - Fax:
Practice Address - Street 1:505 W UNIVERSITY AVE STE 4
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3915
Practice Address - Country:US
Practice Address - Phone:217-954-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional