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NPI Code Detail

MEDICARE: MS. TAMARRA TA'LAYA HICKS MFT- INTERN

MEDICARE: MS. TAMARRA TA'LAYA HICKS MFT- INTERN
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
2106H00000XMarriage & Family Therapist76391CA

General Provider Information

NPI Number : 1598949950
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMARRA TA'LAYA HICKS MFT- INTERN
Provider Business Mailing Address
First Line : 1330 W RAMSEY ST
Second Line :
City : BANNING
State : CA
Zip : 92220-4477
Country : US
Telephone Number : 951-849-7142
Fax Number :
Provider Business Practice Location Address
First Line : 1330 W RAMSEY ST
Second Line :
City : BANNING
State : CA
Zip : 92220-4477
Country : US
Telephone Number : 951-849-7142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2007
Last Update Date : 08/17/2015

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