Provider Demographics
NPI:1013244821
Name:GERMAIN, TARAH NICOLE
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:NICOLE
Last Name:GERMAIN
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 1:333 SUNSET AVE STE 188
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2074
Mailing Address - Country:US
Mailing Address - Phone:707-422-2121
Mailing Address - Fax:707-422-2962
Practice Address - Street 1:3120 FREEBOARD DR STE 102
Practice Address - Street 2:
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5039
Practice Address - Country:US
Practice Address - Phone:530-351-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor