Provider Demographics
NPI:1386766640
Name:MAKELA, TAMMY MICHELLE (LMFT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:MAKELA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25637 JASON PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6600
Mailing Address - Country:US
Mailing Address - Phone:951-486-0616
Mailing Address - Fax:
Practice Address - Street 1:1743 ORANGE TREE LN
Practice Address - Street 2:SUITE A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2857
Practice Address - Country:US
Practice Address - Phone:909-335-1164
Practice Address - Fax:909-793-7466
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41534106H00000X
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool