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NPI Code Detail

MEDICARE: TATTICE LEE BA

MEDICARE: TATTICE LEE BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1134253636
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATTICE LEE BA
Provider Business Mailing Address
First Line : 450 BAUCHET ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90012-2907
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 450 BAUCHET ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90012-2907
Country : US
Telephone Number : 213-473-1789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/18/2012

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Directions to “ TATTICE LEE BA” Practice Location

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