MEDICARE: TARA STROESENREUTHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103K00000X	Behavior Analyst
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114383130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA STROESENREUTHER

Provider Business Mailing Address
First Line	:	115 HIGGINS ST
Second Line	:
City	:	BOONE
State	:	CO
Zip	:	81025-9737
Country	:	US
Telephone Number	:	719-733-3279
Fax Number	:

Provider Business Practice Location Address
First Line	:	6805 CORPORATE DR STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1977
Country	:	US
Telephone Number	:	719-733-3279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	05/12/2022

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Directions to “ TARA STROESENREUTHER ” Practice Location

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