Provider Demographics
NPI:1629683636
Name:TARIN, ATHENA JADE
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:JADE
Last Name:TARIN
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 1:900 N ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-3335
Mailing Address - Country:US
Mailing Address - Phone:308-641-4463
Mailing Address - Fax:
Practice Address - Street 1:900 N ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-3335
Practice Address - Country:US
Practice Address - Phone:800-781-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty