Provider Demographics
NPI:1497235709
Name:TAMM, KATHLEEN CLARE (LICENSED MARRIAGE &)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CLARE
Last Name:TAMM
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE &
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 CORONADO LANE
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:650-345-9669
Mailing Address - Fax:
Practice Address - Street 1:716 CORONADO LANE
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:650-345-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT14974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist