Healthcare Provider Details

I. General information

NPI: 1922401769
Provider Name (Legal Business Name): TAMMIE SUE MAKELY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W ALLUVIAL AVE STE 108
FRESNO CA
93711-5857
US

IV. Provider business mailing address

2540 W SHAW LN STE 107
FRESNO CA
93711-2700
US

V. Phone/Fax

Practice location:
  • Phone: 559-761-9724
  • Fax:
Mailing address:
  • Phone: 559-256-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: