Basic Information
| Provider Information | |||||||||
| NPI: | 1083101877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMOND | ||||||||
| FirstName: | TIANNA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 CALENDAR CT STE 201 | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605256327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086179336 | ||||||||
| FaxNumber: | 7089953806 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 CALENDAR CT STE 201 | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605256327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086179336 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2018 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.