Healthcare Provider Details

I. General information

NPI: 1346810041
Provider Name (Legal Business Name): TARAH SHAE GARIBAY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD STE 215
REDLANDS CA
92373-4724
US

IV. Provider business mailing address

PO BOX 55805
RIVERSIDE CA
92517-0805
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1078
  • Fax:
Mailing address:
  • Phone: 909-530-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9587
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: