Individual
MS. ALICE TASSIE PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
112 A ST, DAVIS, CA 95616-4608
(530) 752-2727
(530) 752-4542
Mailing address
112 A ST, DAVIS, CA 95616-4608
(530) 752-2727
(530) 752-4542
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFC38081
CA
Other
Enumeration date
11/24/2009
Last updated
11/24/2009
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