Provider Demographics
NPI:1679003511
Name:TARVER, TANDREA NICOLE (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:TANDREA
Middle Name:NICOLE
Last Name:TARVER
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:MS
Other - First Name:TANDREA
Other - Middle Name:NICOLE
Other - Last Name:TARVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TANDREA
Mailing Address - Street 1:3031 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3033
Mailing Address - Country:US
Mailing Address - Phone:323-373-2445
Mailing Address - Fax:323-766-3636
Practice Address - Street 1:4401 CRENSHAW BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1200
Practice Address - Country:US
Practice Address - Phone:323-290-8360
Practice Address - Fax:323-290-8366
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist