Provider Demographics
NPI:1386028017
Name:TKACIK, BETH LEWIS
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LEWIS
Last Name:TKACIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 BRADSHAW RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-1033
Mailing Address - Country:US
Mailing Address - Phone:916-821-8318
Mailing Address - Fax:
Practice Address - Street 1:1446 ETHAN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2214
Practice Address - Country:US
Practice Address - Phone:916-922-5110
Practice Address - Fax:916-921-1239
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)