Healthcare Provider Details

I. General information

NPI: 1528246394
Provider Name (Legal Business Name): TAMMY A OUELLETTE PSY.D. APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BREA BLVD SUITE 210
FULLERTON CA
92835-4125
US

IV. Provider business mailing address

1370 BREA BLVD SUITE 210
FULLERTON CA
92835-4125
US

V. Phone/Fax

Practice location:
  • Phone: 714-732-1773
  • Fax: 714-441-1761
Mailing address:
  • Phone: 714-732-1773
  • Fax: 714-441-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY20145
License Number StateCA

VIII. Authorized Official

Name: DR. TAMMY ANN OUELLETTE
Title or Position: CLINICAL PSYCHOLOGIST/CEO
Credential: PSY.D.
Phone: 714-732-1773