Provider Demographics
NPI:1497133755
Name:CLINEFELTER, TARRA
Entity Type:Individual
Prefix:
First Name:TARRA
Middle Name:
Last Name:CLINEFELTER
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 1:1714 SHEA CENTER DR APT 101
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-3524
Mailing Address - Country:US
Mailing Address - Phone:303-797-9440
Mailing Address - Fax:
Practice Address - Street 1:1714 SHEA CENTER DR APT 101
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-3524
Practice Address - Country:US
Practice Address - Phone:303-797-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health