Provider Demographics
NPI:1639959885
Name:TAC TELEPSYCHIATRY
Entity Type:Organization
Organization Name:TAC TELEPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAMBLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-256-5384
Mailing Address - Street 1:718 S LEMON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4626
Mailing Address - Country:US
Mailing Address - Phone:720-256-5384
Mailing Address - Fax:
Practice Address - Street 1:718 S LEMON ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4626
Practice Address - Country:US
Practice Address - Phone:720-256-5384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAC TELEPSYCHIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty