Provider Demographics
NPI:1689822538
Name:CLEARY, TAMMY GAY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:GAY
Last Name:CLEARY
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 1:17401 IRVINE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3038
Mailing Address - Country:US
Mailing Address - Phone:714-734-4244
Mailing Address - Fax:714-983-2333
Practice Address - Street 1:17401 IRVINE BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3038
Practice Address - Country:US
Practice Address - Phone:714-734-4244
Practice Address - Fax:714-983-2333
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical