Provider Demographics
NPI:1669244398
Name:HORTON, TISHA
Entity type:Individual
Prefix:MS
First Name:TISHA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 PEBBLE CREEK DR APT D
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5579
Mailing Address - Country:US
Mailing Address - Phone:714-404-3346
Mailing Address - Fax:
Practice Address - Street 1:11150 W OLYMPIC BLVD STE 1050
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1850
Practice Address - Country:US
Practice Address - Phone:805-273-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor