Provider Demographics
NPI:1578285201
Name:BYRNE, TARA CELINE (CSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CELINE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 S 500 E APT 2
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1137
Mailing Address - Country:US
Mailing Address - Phone:914-384-6733
Mailing Address - Fax:
Practice Address - Street 1:14241 S REDWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5223
Practice Address - Country:US
Practice Address - Phone:801-816-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12919321-3502OtherDOPL