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General NPI Number Information
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NPI Number | 1558836841
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Entity Type | Individual
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Provider Name | TAYARA R EBERHART
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Gender | Female
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 2320 PASEO DEL PRADO STE B208
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City | LAS VEGAS
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State | NV
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Zip | 89102-4332
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Country | US
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Telephone | 702-685-0877
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Fax |
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Provider Business Mailing Address
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Address Line | 3645 TRIPOLI COVE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89106-1105
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Country | US
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Telephone | 702-466-9020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | IC-2318
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License Number State | NV
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