Healthcare Provider Details

I. General information

NPI: 1083768535
Provider Name (Legal Business Name): TARA KLINE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MISSION ST SUITE 1222, 12TH FLOOR
SAN FRANCISCO CA
94105
US

IV. Provider business mailing address

201 MISSION ST SUITE 1222, 12TH FLOOR
SAN FRANCISCO CA
94105
US

V. Phone/Fax

Practice location:
  • Phone: 415-967-2025
  • Fax:
Mailing address:
  • Phone: 415-967-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY29802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: