Provider Demographics
NPI:1629291109
Name:FRIEDKIN, TAMI (MFT)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:FRIEDKIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 ROCHESTER AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7828
Mailing Address - Country:US
Mailing Address - Phone:310-473-0019
Mailing Address - Fax:
Practice Address - Street 1:14724 VENTURA BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3511
Practice Address - Country:US
Practice Address - Phone:310-473-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM.F.T 39784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health