Provider Demographics
NPI:1770684987
Name:TARKINGTON, JUDY E (MS)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:E
Last Name:TARKINGTON
Suffix:
Gender:F
Credentials:MS
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 492541
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-2541
Mailing Address - Country:US
Mailing Address - Phone:530-222-3993
Mailing Address - Fax:530-221-6333
Practice Address - Street 1:191 HARTNELL
Practice Address - Street 2:#200
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-222-3993
Practice Address - Fax:530-221-6333
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11246829OtherCAQH