Healthcare Provider Details

I. General information

NPI: 1386766640
Provider Name (Legal Business Name): TAMMY MICHELLE MAKELA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 ORANGE TREE LN SUITE A
REDLANDS CA
92374-2857
US

IV. Provider business mailing address

25637 JASON PL
MORENO VALLEY CA
92557-6600
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-1164
  • Fax: 909-793-7466
Mailing address:
  • Phone: 951-486-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number41534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: