Provider Demographics
NPI:1184487431
Name:TEN BEAR, JUDE S (CI22151019)
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:S
Last Name:TEN BEAR
Suffix:
Gender:F
Credentials:CI22151019
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33100 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9523
Mailing Address - Country:US
Mailing Address - Phone:530-702-6000
Mailing Address - Fax:
Practice Address - Street 1:33100 COUNTY ROAD 31
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9523
Practice Address - Country:US
Practice Address - Phone:530-702-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI22151019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)