Provider Demographics
NPI:1922386945
Name:TRAEDER, TAMARA (MS, LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:TRAEDER
Suffix:
Gender:F
Credentials:MS, LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-0523
Mailing Address - Country:US
Mailing Address - Phone:510-414-7784
Mailing Address - Fax:
Practice Address - Street 1:1299 PINE ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1829
Practice Address - Country:US
Practice Address - Phone:510-414-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57798106H00000X
CAMFC 50853106H00000X
CALPC 1646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional