Provider Demographics
NPI:1326120916
Name:MCGRATH, TARA EILEEN (MFT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:EILEEN
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:EILEEN
Other - Last Name:KELSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:591 CAMINO DE LA REINA STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:591 CAMINO DE LA REINA STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3104
Practice Address - Country:US
Practice Address - Phone:619-206-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54570106H00000X
CA52963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist