Provider Demographics
NPI:1396864997
Name:KLUMPE, TAMARA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:J
Last Name:KLUMPE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:J
Other - Last Name:SHERAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1418
Mailing Address - Country:US
Mailing Address - Phone:818-952-2730
Mailing Address - Fax:818-790-0219
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1418
Practice Address - Country:US
Practice Address - Phone:818-952-2730
Practice Address - Fax:818-790-0219
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4106103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
133067OtherVALUE OPTIONS
CACP4106Medicare ID - Type Unspecified