Healthcare Provider Details

I. General information

NPI: 1407358898
Provider Name (Legal Business Name): CHEZIA TARLETON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HURLEY WAY STE 110
SACRAMENTO CA
95825-3213
US

IV. Provider business mailing address

1500 WEST EL CAMINO AVENUE STE 13, PO BOX 146
SACRAMENTO CA
95833-4360
US

V. Phone/Fax

Practice location:
  • Phone: 916-360-0838
  • Fax:
Mailing address:
  • Phone: 704-964-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150974
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: