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NPI Code Detail

MEDICARE: DR. TYLENE ARLOA CAMMACK-BARRY PSY.D.

MEDICARE:  DR. TYLENE ARLOA CAMMACK-BARRY  PSY.D.
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
1101YM0800XMental Health Counselor
2103TC2200XClinical Child & Adolescent PsychologistPSY21315CA

General Provider Information

NPI Number : 1417901679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLENE ARLOA CAMMACK-BARRY PSY.D.
Provider Business Mailing Address
First Line : 6409 BLUE POPPY DR
Second Line :
City : ELK GROVE
State : CA
Zip : 95757-8307
Country : US
Telephone Number : 916-686-0964
Fax Number :
Provider Business Practice Location Address
First Line : 3671 BUSINESS DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-2197
Country : US
Telephone Number : 916-734-4207
Fax Number : 916-734-4150
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 01/03/2022

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