Provider Demographics
NPI:1598922593
Name:GUNTHER, TARA J (PSYD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:JEAN
Other - Last Name:WITTKOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:12311 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8344
Mailing Address - Country:US
Mailing Address - Phone:878-332-4240
Mailing Address - Fax:878-332-4481
Practice Address - Street 1:12311 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:878-332-4240
Practice Address - Fax:878-332-4481
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018000103TC0700X
MO2008015692103TC0700X
KS1731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103094504Medicaid
PA103094504Medicaid