Provider Demographics
NPI:1558835256
Name:HARTSOCK, TIA (MS, APCC)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:HARTSOCK
Suffix:
Gender:F
Credentials:MS, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 N PALM AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2271
Mailing Address - Country:US
Mailing Address - Phone:595-449-2734
Mailing Address - Fax:
Practice Address - Street 1:5151 N PALM AVE STE 500
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2271
Practice Address - Country:US
Practice Address - Phone:595-449-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional