Provider Demographics
NPI:1407358898
Name:TARLETON, CHEZIA
Entity type:Individual
Prefix:
First Name:CHEZIA
Middle Name:
Last Name:TARLETON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WEST EL CAMINO AVENUE
Mailing Address - Street 2:STE 13, PO BOX 146
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-4360
Mailing Address - Country:US
Mailing Address - Phone:704-964-4212
Mailing Address - Fax:
Practice Address - Street 1:1010 HURLEY WAY STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3213
Practice Address - Country:US
Practice Address - Phone:916-360-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 106S00000X, 171M00000X
CA150974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator