MEDICARE: DENALI TICE MD INC.

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
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1669155842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENALI TICE MD INC.

Provider Business Mailing Address
First Line	:	PO BOX 803
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95763-0803
Country	:	US
Telephone Number	:	916-400-9037
Fax Number	:	608-888-1793

Provider Business Practice Location Address
First Line	:	850 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-9009
Country	:	US
Telephone Number	:	916-400-9037
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENALI TICE
Credential	:	MD
Telephone Number	:	916-400-9037

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	02/17/2026

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