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General NPI Number Information
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NPI Number | 1962792242
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Entity Type | Individual
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Provider Name | TAMARA LEIGH SEVERN M.A., MFT
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Gender | Female
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 455 I ST STE 203
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City | ARCATA
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State | CA
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Zip | 95521-6195
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Country | US
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Telephone | 707-834-3747
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | CUTTEN
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State | CA
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Zip | 95534-0002
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Country | US
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Telephone | 707-834-3747
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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 | 49815
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License Number State | CA
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