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General NPI Number Information
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NPI Number | 1629584511
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Entity Type | Organization
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Legal Business Name | TAPAS YOGA SHALA
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 100 19TH ST STE 102
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City | ROCK ISLAND
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State | IL
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Zip | 61201-8022
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Country | US
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Telephone | 309-236-9553
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Fax |
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Provider Business Mailing Address
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Address Line | 100 19TH ST STE 102
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City | ROCK ISLAND
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State | IL
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Zip | 61201-8022
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Country | US
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Telephone | 309-236-9553
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVAN HARRIS
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Credential | LCSW, LISW
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Telephone | 309-236-9553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 008410
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.019633
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License Number State | IL
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