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General NPI Number Information
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NPI Number | 1710115142
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Entity Type | Individual
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Provider Name | MS. TARA BOSWELL
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Gender | Female
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 180 W HUFFAKER LN # 302-303
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City | RENO
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State | NV
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Zip | 89511
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Country | US
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Telephone | 775-391-0521
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CALIFORNIA AVE APT 11
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City | RENO
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State | NV
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Zip | 89509-1618
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Country | US
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Telephone | 602-502-0161
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MI0120
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY0855
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License Number State | NV
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