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NPI Code Detail

MEDICARE: TIA ATWELL

MEDICARE: TIA ATWELL
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1467265249
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIA ATWELL
Provider Business Mailing Address
First Line : 301 N LAKE AVE STE 600
Second Line :
City : PASADENA
State : CA
Zip : 91101-5129
Country : US
Telephone Number : 626-354-6440
Fax Number :
Provider Business Practice Location Address
First Line : 301 N LAKE AVE STE 600
Second Line :
City : PASADENA
State : CA
Zip : 91101-5129
Country : US
Telephone Number : 626-354-6440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2025
Last Update Date : 02/02/2025

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Directions to “ TIA ATWELL ” Practice Location

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