Provider Demographics
NPI:1114383130
Name:STROESENREUTHER, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:STROESENREUTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:DEVRIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:CO
Mailing Address - Zip Code:81025-9737
Mailing Address - Country:US
Mailing Address - Phone:719-733-3279
Mailing Address - Fax:
Practice Address - Street 1:6805 CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1977
Practice Address - Country:US
Practice Address - Phone:719-733-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst