Provider Demographics
NPI:1871624916
Name:TOOKE, TARISA (LMFT)
Entity type:Individual
Prefix:
First Name:TARISA
Middle Name:
Last Name:TOOKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TARI
Other - Middle Name:
Other - Last Name:TOOKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5225 CANYON CREST DR STE 103
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6353
Mailing Address - Country:US
Mailing Address - Phone:323-384-4154
Mailing Address - Fax:
Practice Address - Street 1:10800 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3043
Practice Address - Country:US
Practice Address - Phone:323-384-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF52618106H00000X
CA47616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist