Provider Demographics
NPI:1265261713
Name:CUMBOW, TARA LYNN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:CUMBOW
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 1:32 W WATERBURY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8115
Mailing Address - Country:US
Mailing Address - Phone:937-416-8576
Mailing Address - Fax:
Practice Address - Street 1:32 W WATERBURY DR
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8115
Practice Address - Country:US
Practice Address - Phone:937-416-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical