Provider Demographics
NPI:1154346070
Name:TICHY, GEORGES ALEXANDRE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:ALEXANDRE
Last Name:TICHY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 FOOTE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3012
Mailing Address - Country:US
Mailing Address - Phone:951-743-0642
Mailing Address - Fax:951-352-2986
Practice Address - Street 1:8787 CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3034
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY178330Medicaid
CAPSY178330Medicaid
CAP00293710Medicare ID - Type UnspecifiedRAIL ROAD
CA0PL178330Medicare ID - Type UnspecifiedMEDICARE