Provider Demographics
NPI:1366057069
Name:HIGH, CHANNAN TARE'
Entity type:Individual
Prefix:
First Name:CHANNAN
Middle Name:TARE'
Last Name:HIGH
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 1:2841 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2133
Mailing Address - Country:US
Mailing Address - Phone:209-722-0202
Mailing Address - Fax:209-385-9921
Practice Address - Street 1:2841 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2133
Practice Address - Country:US
Practice Address - Phone:209-722-0202
Practice Address - Fax:209-385-9921
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker