Basic Information
| Provider Information | |||||||||
| NPI: | 1558465716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIEMANN | ||||||||
| FirstName: | KAY | ||||||||
| MiddleName: | AMANDA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TIEMANN | ||||||||
| OtherFirstName: | KATY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1801 VICENTE STREET | ||||||||
| Address2: | THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941162923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156813211 | ||||||||
| FaxNumber: | 4156647094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 VICENTE STREET | ||||||||
| Address2: | THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941162923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156813211 | ||||||||
| FaxNumber: | 4156647094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF38916 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.