Provider Demographics
NPI:1710011275
Name:EXUM, TAMMY ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:ANN
Last Name:EXUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E. SHAW AVENUE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-248-8550
Mailing Address - Fax:559-248-8555
Practice Address - Street 1:1630 E. SHAW AVENUE
Practice Address - Street 2:SUITE 150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-248-8550
Practice Address - Fax:559-248-8555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist