Provider Demographics
NPI:1295137040
Name:FAVELA, TRICIA (BA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:FAVELA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 FOX RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7035
Mailing Address - Country:US
Mailing Address - Phone:909-649-3012
Mailing Address - Fax:
Practice Address - Street 1:546 FOX RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7035
Practice Address - Country:US
Practice Address - Phone:909-649-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1199241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical