Healthcare Provider Details

I. General information

NPI: 1801708375
Provider Name (Legal Business Name): TARAMAY ROSE KOONTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA MAY KOONTZ

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 SW LAKEVIEW DR
GRAIN VALLEY MO
64029-8415
US

IV. Provider business mailing address

713 SW LAKEVIEW DR
GRAIN VALLEY MO
64029-8415
US

V. Phone/Fax

Practice location:
  • Phone: 816-846-1754
  • Fax:
Mailing address:
  • Phone: 816-846-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: