Basic Information
| Provider Information | |||||||||
| NPI: | 1164615464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODRICH | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8421 AUBURN BLVD | ||||||||
| Address2: | BUILDING #3 | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956100359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
| FaxNumber: | 9167229229 | ||||||||
| Practice Location | |||||||||
| Address1: | 8421 AUBURN BLVD | ||||||||
| Address2: | BUILDING #3 | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956100359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
| FaxNumber: | 9167229229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MFC 52927 | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.