Healthcare Provider Details

I. General information

NPI: 1225623283
Provider Name (Legal Business Name): TAMARA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-4011
  • Fax:
Mailing address:
  • Phone: 530-885-4011
  • 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: