Healthcare Provider Details

I. General information

NPI: 1588836886
Provider Name (Legal Business Name): KENNETH A. TAMBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 WALNUT DR
EUREKA CA
95503
US

IV. Provider business mailing address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2000
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-8722
  • Fax:
Mailing address:
  • Phone: 213-385-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: