Provider Demographics
NPI:1316121585
Name:LADOU, TAMSEN WILLITS (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMSEN
Middle Name:WILLITS
Last Name:LADOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:CA
Mailing Address - Zip Code:92036-0178
Mailing Address - Country:US
Mailing Address - Phone:760-994-6450
Mailing Address - Fax:
Practice Address - Street 1:32605 TEMECULA PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6837
Practice Address - Country:US
Practice Address - Phone:760-994-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEW067AOtherMEDICARE PTAN