=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285954008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTIN HOWARD TAMKIN LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2010
-----------------------------------------------------
Last Update Date | 06/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S EUCLID AVE SUITE #1
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-251-5592
-----------------------------------------------------
Fax | 323-927-1857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 987
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80201-0987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-251-5592
-----------------------------------------------------
Fax | 323-927-1857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 44861
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------