Provider Demographics
NPI:1669631503
Name:GANGLOFF, TAMIE DAWN
Entity Type:Individual
Prefix:
First Name:TAMIE
Middle Name:DAWN
Last Name:GANGLOFF
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 1:25 W ANAPAMU ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-5148
Mailing Address - Country:US
Mailing Address - Phone:805-730-7575
Mailing Address - Fax:
Practice Address - Street 1:25 W ANAPAMU ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-5148
Practice Address - Country:US
Practice Address - Phone:805-730-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)