Provider Demographics
NPI:1275677270
Name:EYTCHESON, TARA L
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:EYTCHESON
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 1:1539 E 100 N
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-3413
Mailing Address - Country:US
Mailing Address - Phone:765-450-5657
Mailing Address - Fax:765-450-6353
Practice Address - Street 1:1539 E 100 N
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-3413
Practice Address - Country:US
Practice Address - Phone:765-450-5657
Practice Address - Fax:765-450-6353
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor