Provider Demographics
NPI:1134367832
Name:TABISH, RAINIE D (PSYD)
Entity type:Individual
Prefix:
First Name:RAINIE
Middle Name:D
Last Name:TABISH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-0394
Mailing Address - Country:US
Mailing Address - Phone:916-622-2620
Mailing Address - Fax:
Practice Address - Street 1:2235 DOUGLAS BLVD
Practice Address - Street 2:STE 500
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4266
Practice Address - Country:US
Practice Address - Phone:916-622-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical