MEDICARE: TARA MARIE KRAMLICH TREBESCH ACMHC, IHP, CFA, CN

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801779087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MARIE KRAMLICH TREBESCH ACMHC, IHP, CFA, CN

Provider Business Mailing Address
First Line	:	PO BOX 683060
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84068-3060
Country	:	US
Telephone Number	:	435-565-1722
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 SIDEWINDER DR STE 201
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7257
Country	:	US
Telephone Number	:	435-565-1722
Fax Number	:

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

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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