Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY15916 | CA |
N | 103TC0700X | Clinical Psychologist | PSY15916 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY15916 | CA |
NPI | 1073671228 |
---|---|
Provider Name | Dr. Tamara Lynn Elkins |
First Address | Modesto, CA 95354-1029 |
Second Address | Modesto, CA 95354-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY159160 | (05) | CA |