Provider Information for 1487057980
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TISHAWNA CHAREE MIMS LMFT
Sex: Female
NPI: 1487057980
Last Updated: 2021-03-19
Certification Date: 2021-03-19
Certification Date: 2021-03-19
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1487057980 | ||||||||||||
| Enumeration Date | 2014-09-29 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 1000 BAKERSFIELD, CA 93302-1000 United States Phone: 661-868-6100 | Fax:661-868-6133 | ||||||||||||
| Primary Practice Address | 5121 STOCKDALE HWY STE 150A BAKERSFIELD, CA 93309-2656 United States Phone: 661-868-5081 | Fax:661-836-3005 | ||||||||||||
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