Provider Demographics
NPI:1659375053
Name:TARRANT, JEFFREY MATTHEW (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:TARRANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6405
Mailing Address - Country:US
Mailing Address - Phone:573-447-1079
Mailing Address - Fax:
Practice Address - Street 1:211 OSCAR DR
Practice Address - Street 2:STE A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5197
Practice Address - Country:US
Practice Address - Phone:573-635-8299
Practice Address - Fax:573-635-4629
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist