Provider Demographics
NPI:1033520333
Name:MICHALOWSKI, TARA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:MICHALOWSKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:ASHFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:17217 CALIPATRIA LN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6219
Mailing Address - Country:US
Mailing Address - Phone:760-405-6764
Mailing Address - Fax:
Practice Address - Street 1:17217 CALIPATRIA LN
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6219
Practice Address - Country:US
Practice Address - Phone:760-405-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001272106H00000X
CALMFT100197106H00000X
TX203549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist