Provider Demographics
NPI:1417101940
Name:STOWELL, TARAH RACHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:RACHELE
Last Name:STOWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 BRIDLE WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-2112
Mailing Address - Country:US
Mailing Address - Phone:801-243-9994
Mailing Address - Fax:
Practice Address - Street 1:2465 KILBY RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-8212
Practice Address - Country:US
Practice Address - Phone:801-243-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT542213935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical