Provider Demographics
NPI:1790825644
Name:WINKLER, TARA KAI (EDS)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:KAI
Last Name:WINKLER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12552 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5527
Mailing Address - Country:US
Mailing Address - Phone:623-691-3118
Mailing Address - Fax:623-691-3120
Practice Address - Street 1:2550 N 79TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-1225
Practice Address - Country:US
Practice Address - Phone:623-691-3118
Practice Address - Fax:623-691-3120
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3794942103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool