Provider Demographics
NPI:1518709591
Name:WRIGHT, TARA JACQUELEEN (BSE, CMPSS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JACQUELEEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BSE, CMPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 CHAPALA ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3947
Mailing Address - Country:US
Mailing Address - Phone:805-617-3007
Mailing Address - Fax:
Practice Address - Street 1:2013 CHAPALA ST APT 4
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3947
Practice Address - Country:US
Practice Address - Phone:805-617-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-CFKOYZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist