Healthcare Provider Details

I. General information

NPI: 1659375053
Provider Name (Legal Business Name): JEFFREY MATTHEW TARRANT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OSCAR DR STE A
JEFFERSON CITY MO
65101-5197
US

IV. Provider business mailing address

4318 SUSSEX DR
COLUMBIA MO
65203-6405
US

V. Phone/Fax

Practice location:
  • Phone: 573-635-8299
  • Fax: 573-635-4629
Mailing address:
  • Phone: 573-447-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01931
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: