Provider Demographics
NPI:1649687880
Name:LOSINSKI, TARA (LAC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LOSINSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16351 I94
Mailing Address - Street 2:HOME ON THE RANGE
Mailing Address - City:SENTINEL BUTTE
Mailing Address - State:ND
Mailing Address - Zip Code:58654-9500
Mailing Address - Country:US
Mailing Address - Phone:701-872-3745
Mailing Address - Fax:701-872-3748
Practice Address - Street 1:16351 I94
Practice Address - Street 2:HOME ON THE RANGE
Practice Address - City:SENTINEL BUTTE
Practice Address - State:ND
Practice Address - Zip Code:58654-9500
Practice Address - Country:US
Practice Address - Phone:701-872-3745
Practice Address - Fax:701-872-3748
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 171M00000X
ND1741101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator