Healthcare Provider Details

I. General information

NPI: 1629138243
Provider Name (Legal Business Name): TARA MARIE NEAVINS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY BLDG 649
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY BLDG 649
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5449
  • Fax: 916-366-5441
Mailing address:
  • Phone: 916-366-5449
  • Fax: 916-366-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: