Provider Demographics
NPI:1679355069
Name:WELBORNE, TAMMY RENEE (LPC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENEE
Last Name:WELBORNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 COUNTY ROAD 905
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-3910
Mailing Address - Country:US
Mailing Address - Phone:682-378-6612
Mailing Address - Fax:
Practice Address - Street 1:3461 COUNTY ROAD 905
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-3910
Practice Address - Country:US
Practice Address - Phone:682-378-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional