Healthcare Provider Details

I. General information

NPI: 1720742455
Provider Name (Legal Business Name): TUNISIA RADER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 HELLING WAY
NEVADA CITY CA
95959-8619
US

IV. Provider business mailing address

995 HELLING WAY
NEVADA CITY CA
95959-8619
US

V. Phone/Fax

Practice location:
  • Phone: 530-802-1027
  • Fax:
Mailing address:
  • Phone: 530-802-1027
  • 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: