Provider Demographics
NPI:1508611278
Name:NEWTON, TARA J
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:NEWTON
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 1:1016 MILLDALE RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8672
Mailing Address - Country:US
Mailing Address - Phone:740-716-8155
Mailing Address - Fax:
Practice Address - Street 1:519 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3933
Practice Address - Country:US
Practice Address - Phone:740-876-4370
Practice Address - Fax:740-529-1818
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPS.004929OtherSTATE OF OHIO MENTAL HEALTH AND ADDICTION SERVICES