Provider Demographics
NPI:1699793687
Name:TICKNER, CHRIS (MA, MFT)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:TICKNER
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 FERNGLEN AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1552
Mailing Address - Country:US
Mailing Address - Phone:818-352-7911
Mailing Address - Fax:
Practice Address - Street 1:1191 E WALNUT ST
Practice Address - Street 2:SUITE #104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1868
Practice Address - Country:US
Practice Address - Phone:818-568-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist