Provider Demographics
NPI:1497453609
Name:TACTAY, JAMIE F
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:F
Last Name:TACTAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 JOEBAR CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6254
Mailing Address - Country:US
Mailing Address - Phone:916-509-1684
Mailing Address - Fax:
Practice Address - Street 1:9822 JOEBAR CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6254
Practice Address - Country:US
Practice Address - Phone:916-509-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT118789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist