Provider Demographics
NPI:1144063363
Name:CHELEW, TAMI GWEN (LMFT)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:GWEN
Last Name:CHELEW
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 1:16289 OAK CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1703
Mailing Address - Country:US
Mailing Address - Phone:858-829-6074
Mailing Address - Fax:
Practice Address - Street 1:201 LOMAS SANTA FE DR STE 490
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1287
Practice Address - Country:US
Practice Address - Phone:858-254-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79759102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst