Healthcare Provider Details

I. General information

NPI: 1346964970
Provider Name (Legal Business Name): TINA JAVIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date: 09/12/2024
Reactivation Date: 03/25/2026

III. Provider practice location address

1359 E LASSEN AVE
CHICO CA
95973-7824
US

IV. Provider business mailing address

5115 B AVENUE PL
KEARNEY NE
68847-8563
US

V. Phone/Fax

Practice location:
  • Phone: 230-230-9230
  • Fax: 530-466-3154
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: