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General NPI Number Information
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NPI Number | 1174363295
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Entity Type | Individual
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Provider Name | TAMARA BAILEY PHD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 11030 SANTA MONICA BLVD STE 302
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City | LOS ANGELES
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State | CA
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Zip | 90025-7590
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Country | US
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Telephone | 310-715-9319
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Fax |
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Provider Business Mailing Address
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Address Line | 1534 10TH ST APT 4
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City | SANTA MONICA
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State | CA
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Zip | 90401-2866
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Country | US
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Telephone | 310-715-9319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 94025771
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License Number State | CA
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