MEDICARE: MS. TAMAR A PRERO LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3638013501	UT

General Provider Information

NPI Number	:	1144287632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMAR A PRERO LCSW

Provider Business Mailing Address
First Line	:	3191 VALLEY ST
Second Line	:	SUITE 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-4274
Country	:	US
Telephone Number	:	801-403-3357
Fax Number	:	801-585-2818

Provider Business Practice Location Address
First Line	:	3191 VALLEY ST
Second Line	:	SUITE 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-4274
Country	:	US
Telephone Number	:	801-403-3357
Fax Number	:	801-585-2818

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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