Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103G00000X | Clinical Psychologist | PSY21559 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY21559 | CA |
NPI | 1013056126 |
---|---|
Provider Name | Dr. Tamar A. Bourian-Manuelian |
First Address | Montebello, CA 90640-1023 |
Second Address | Whittier, CA 90602-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 18/09/2018 |