Doctor Name: | TENAYA IDEKER |
NPI Number: | 1184041220 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | ASW60982 |
Business Practice Address: | 10121 Pine Ave Truckee, CA - 961614835 |
Business Phone Number: | 5305823208 |
Business Fax Number: | 5305823201 |
Mailing Address: | 10121 Pine Ave, TRUCKEE |
State: | CA |
Postal Code: | 961614835 |
Phone Number: | 5305823208 |
Fax Number: | 5305823201 |
NPI Enumeration Date: | 03/26/2014 |
NPI Last Update Date: | 01/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | ASW60982 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |