Provider Demographics
NPI:1558504944
Name:DANIEL, TAMARA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:MICHELLE
Last Name:DANIEL
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 1:4001 INGLEWOOD AVE # 101-165
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1121
Mailing Address - Country:US
Mailing Address - Phone:559-905-6724
Mailing Address - Fax:
Practice Address - Street 1:6518 N LODI AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3654
Practice Address - Country:US
Practice Address - Phone:559-905-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist