Provider Demographics
NPI:1659986933
Name:TARBY, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TARBY
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 1:1700 FORUM BLVD APT 2609
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6346
Mailing Address - Country:US
Mailing Address - Phone:773-977-6457
Mailing Address - Fax:
Practice Address - Street 1:1804 HERIFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1942
Practice Address - Country:US
Practice Address - Phone:573-203-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MO2020033173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health