Healthcare Provider Details

I. General information

NPI: 1972795409
Provider Name (Legal Business Name): TARA L SYLVESTER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 HIGH SIERRA BLVD
BILLINGS MT
59105-5411
US

IV. Provider business mailing address

1860 HIGH SIERRA BLVD
BILLINGS MT
59105-5411
US

V. Phone/Fax

Practice location:
  • Phone: 406-855-6034
  • Fax: 406-494-1724
Mailing address:
  • Phone: 406-855-6034
  • Fax: 406-494-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1031
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: