Provider Demographics
NPI:1821599002
Name:RAUCH, TARASA LYNNAE (MED QMHS)
Entity type:Individual
Prefix:
First Name:TARASA
Middle Name:LYNNAE
Last Name:RAUCH
Suffix:
Gender:F
Credentials:MED QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9233
Mailing Address - Country:US
Mailing Address - Phone:740-788-8851
Mailing Address - Fax:740-788-8851
Practice Address - Street 1:14 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9233
Practice Address - Country:US
Practice Address - Phone:740-788-8851
Practice Address - Fax:740-788-8851
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2002936-TRNE101Y00000X
174400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174400000XOther Service ProvidersSpecialist