Provider Demographics
NPI:1861239576
Name:PHILLIPS, TAMARA JORDANNA (LMFT)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:JORDANNA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 UNIVERSITY ACRES DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3024
Mailing Address - Country:US
Mailing Address - Phone:407-448-0727
Mailing Address - Fax:
Practice Address - Street 1:2612 UNIVERSITY ACRES DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3024
Practice Address - Country:US
Practice Address - Phone:407-448-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist