MEDICARE: MRS. STEPHANIE LYNN TAMBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	74507	CA

General Provider Information

NPI Number	:	1043552888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE LYNN TAMBE

Provider Business Mailing Address
First Line	:	2503 PARK RD
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3350
Country	:	US
Telephone Number	:	805-889-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 PARK RD
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3350
Country	:	US
Telephone Number	:	805-889-1066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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