Provider Demographics
NPI:1912025297
Name:ETIAKA, TABARA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TABARA
Middle Name:
Last Name:ETIAKA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:TABARA
Other - Middle Name:
Other - Last Name:HEARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3939 ATLANTIC AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3529
Mailing Address - Country:US
Mailing Address - Phone:562-230-1039
Mailing Address - Fax:
Practice Address - Street 1:830 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4513
Practice Address - Country:US
Practice Address - Phone:562-285-0149
Practice Address - Fax:562-285-0156
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CALMFT91151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner