Provider Demographics
NPI:1417599093
Name:TARRYK, TINA MARIE (MHC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:TARRYK
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 INDIAN POINT ST # 9D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-5555
Mailing Address - Country:US
Mailing Address - Phone:833-246-6624
Mailing Address - Fax:
Practice Address - Street 1:241 INDIAN POINT ST # 9D
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5555
Practice Address - Country:US
Practice Address - Phone:833-246-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program