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General NPI Number Information
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NPI Number | 1801963467
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Entity Type | Individual
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Provider Name | TAMARA RIDGE MS LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 680 E. COLORADO BLVD SUITE 180 & SECOND FLOOR
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City | PASADENA
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State | CA
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Zip | 91101-6143
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Country | US
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Telephone | 626-657-0061
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Fax |
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Provider Business Mailing Address
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Address Line | 19070 STODDARD WAY
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City | APPLE VALLEY
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State | CA
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Zip | 92308-4975
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Country | US
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Telephone | 323-430-0702
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC37840
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License Number State | CA
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