MEDICARE: MS. TISHA HORTON

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1669244398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TISHA HORTON

Provider Business Mailing Address
First Line	:	4412 PEBBLE CREEK DR APT D
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-5579
Country	:	US
Telephone Number	:	714-404-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	11150 W OLYMPIC BLVD STE 1050
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1850
Country	:	US
Telephone Number	:	805-273-4905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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