Provider Demographics
NPI:1801963467
Name:RIDGE, TAMARA (MS LMFT)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:RIDGE
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:RIDGE
Other - Last Name:BESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LMFT
Mailing Address - Street 1:19070 STODDARD WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-4975
Mailing Address - Country:US
Mailing Address - Phone:323-430-0702
Mailing Address - Fax:
Practice Address - Street 1:680 E. COLORADO BLVD
Practice Address - Street 2:SUITE 180 & SECOND FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6143
Practice Address - Country:US
Practice Address - Phone:626-657-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37840106H00000X
UT57726503902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist