Healthcare Provider Details

I. General information

NPI: 1417901679
Provider Name (Legal Business Name): TYLENE ARLOA CAMMACK-BARRY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 BUSINESS DR
SACRAMENTO CA
95820-2197
US

IV. Provider business mailing address

6409 BLUE POPPY DR
ELK GROVE CA
95757-8307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-4207
  • Fax: 916-734-4150
Mailing address:
  • Phone: 916-686-0964
  • 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 Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY21315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: