Provider Demographics
NPI:1336912468
Name:TABULA RASA INC
Entity Type:Organization
Organization Name:TABULA RASA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-244-3737
Mailing Address - Street 1:27094 RIDGEVIEW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-6033
Mailing Address - Country:US
Mailing Address - Phone:605-891-4377
Mailing Address - Fax:
Practice Address - Street 1:27094 RIDGEVIEW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-6033
Practice Address - Country:US
Practice Address - Phone:605-891-4377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty