Provider Demographics
NPI:1073974481
Name:VAN FLEET, TAMMY (PHD, BCBA-D, CBIS)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:VAN FLEET
Suffix:
Gender:F
Credentials:PHD, BCBA-D, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 BALBOA BLVD
Mailing Address - Street 2:SUITE 163
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1519
Mailing Address - Country:US
Mailing Address - Phone:805-506-3390
Mailing Address - Fax:
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:SUITE 163
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:805-506-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst