Provider Demographics
NPI:1639514383
Name:MATUS, TARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:MATUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 VERDE VIS
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1315
Mailing Address - Country:US
Mailing Address - Phone:512-207-0678
Mailing Address - Fax:512-259-9465
Practice Address - Street 1:12001 W PARMER LN
Practice Address - Street 2:SUITE 200
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7767
Practice Address - Country:US
Practice Address - Phone:512-763-9278
Practice Address - Fax:512-259-9465
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36259103TM1800X, 103TP2701X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy