Provider Demographics
NPI:1801077383
Name:BORSH, TARA RENEE SNYDER (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:RENEE SNYDER
Last Name:BORSH
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:RENEE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:6460 MEDICAL CENTER ST, STE 140
Mailing Address - Street 2:BOYS TOWN NEVADA, INC.
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2420
Mailing Address - Country:US
Mailing Address - Phone:702-888-1340
Mailing Address - Fax:702-888-1342
Practice Address - Street 1:6460 MEDICAL CENTER ST, STE 140
Practice Address - Street 2:BOYS TOWN NEVADA, INC.
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2420
Practice Address - Country:US
Practice Address - Phone:702-888-1340
Practice Address - Fax:702-888-1342
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0786103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026172100Medicaid
NE10026232000Medicaid
NE10026304600Medicaid
NE10026510900Medicaid
NE10026412500Medicaid