Provider Demographics
NPI:1841430568
Name:TAMARKIN, MICHELE LYNNE (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNNE
Last Name:TAMARKIN
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 1:12335 SANTA MONICA BLVD # 138
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2519
Mailing Address - Country:US
Mailing Address - Phone:310-463-0403
Mailing Address - Fax:661-476-5455
Practice Address - Street 1:12335 SANTA MONICA BLVD # 138
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2519
Practice Address - Country:US
Practice Address - Phone:310-463-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist