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General NPI Number Information
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NPI Number | 1861978447
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Entity Type | Individual
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Provider Name | TARYN WISE PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 6900 HOUSTON RD STE 11
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City | FLORENCE
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State | KY
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Zip | 41042-4891
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Country | US
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Telephone | 859-525-4911
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Fax |
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Provider Business Mailing Address
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Address Line | 4 AUGUSTA AVE
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City | FT WRIGHT
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State | KY
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Zip | 41011-3604
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Country | US
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Telephone | 502-724-2017
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 269154
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License Number State | KY
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