Provider Demographics
NPI:1669432589
Name:OUELLETTE, TAMMY ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ANN
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 BREA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4125
Mailing Address - Country:US
Mailing Address - Phone:714-732-1773
Mailing Address - Fax:714-441-1761
Practice Address - Street 1:1370 BREA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4128
Practice Address - Country:US
Practice Address - Phone:714-732-1773
Practice Address - Fax:714-441-1761
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20145103G00000X, 103TH0004X
CAPSY 20145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth