Provider Demographics
NPI:1417901679
Name:CAMMACK-BARRY, TYLENE ARLOA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TYLENE
Middle Name:ARLOA
Last Name:CAMMACK-BARRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 BLUE POPPY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8307
Mailing Address - Country:US
Mailing Address - Phone:916-686-0964
Mailing Address - Fax:
Practice Address - Street 1:3671 BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2197
Practice Address - Country:US
Practice Address - Phone:916-734-4207
Practice Address - Fax:916-734-4150
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY21315103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health