Provider Demographics
NPI:1245512011
Name:BOSTWICK, TARYN (MA)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:
Other - Last Name:BAXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2002-B WEST 120TH AVE
Mailing Address - Street 2:#2
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:720-304-5570
Mailing Address - Fax:
Practice Address - Street 1:2002-B WEST 120TH AVE
Practice Address - Street 2:#2
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:720-304-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-6214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional