Provider Demographics
NPI:1083065577
Name:MARSHALL, TARAH (BCBA)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 ARGYLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5812
Mailing Address - Country:US
Mailing Address - Phone:505-670-3314
Mailing Address - Fax:
Practice Address - Street 1:5311 ARGYLE WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5812
Practice Address - Country:US
Practice Address - Phone:505-670-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-16-7194103K00000X
TX1-16-24357103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst