Provider Demographics
NPI:1538298088
Name:PEDDIE-MUSSER, TAMARA MARJORIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MARJORIE
Last Name:PEDDIE-MUSSER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 RANCHEROS DR
Mailing Address - Street 2:298
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2900
Mailing Address - Country:US
Mailing Address - Phone:760-752-4913
Mailing Address - Fax:
Practice Address - Street 1:340 RANCHEROS DR
Practice Address - Street 2:298
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2900
Practice Address - Country:US
Practice Address - Phone:760-752-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist