Healthcare Provider Details

I. General information

NPI: 1679619803
Provider Name (Legal Business Name): MS. TERI ANN TIBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 SKYWAY
PARADISE CA
95969
US

IV. Provider business mailing address

2335 D ST
OROVILLE CA
95966-6605
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-1965
  • Fax: 530-877-1978
Mailing address:
  • Phone: 530-533-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: