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General NPI Number Information
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NPI Number | 1841836244
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Entity Type | Individual
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Provider Name | MARY J TICHACEK RN, PMHNP-BC, PMHCNS
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 11515 EL CAMINO REAL STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92130-3034
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Country | US
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Telephone | 858-279-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 11515 EL CAMINO REAL STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92130-3034
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Country | US
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Telephone | 858-279-1223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 202048
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95024198
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 207
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License Number State | CA
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