Healthcare Provider Details

I. General information

NPI: 1669957999
Provider Name (Legal Business Name): MR. IAN TAYLOR FIKSDAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

146 W LASSEN AVE APT 36
CHICO CA
95973-0145
US

V. Phone/Fax

Practice location:
  • Phone: 530-895-6555
  • Fax:
Mailing address:
  • Phone: 530-519-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: