Provider Demographics
NPI:1326152497
Name:NOWLING, TARA L
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:NOWLING
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 1:4612 ROSEVILLE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5175
Mailing Address - Country:US
Mailing Address - Phone:916-344-0199
Mailing Address - Fax:916-344-0196
Practice Address - Street 1:4612 ROSEVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5175
Practice Address - Country:US
Practice Address - Phone:916-344-0199
Practice Address - Fax:916-344-0196
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 39815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist