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NPI Code Detail

MEDICARE: MISS TARA LEE BURKETT

MEDICARE: MISS TARA LEE BURKETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program
3106H00000XMarriage & Family Therapist74919CA

General Provider Information

NPI Number : 1306977384
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TARA LEE BURKETT
Provider Business Mailing Address
First Line : 6950 65TH ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-2316
Country : US
Telephone Number : 925-784-4210
Fax Number :
Provider Business Practice Location Address
First Line : 6950 65TH ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-2316
Country : US
Telephone Number : 925-784-4210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 02/07/2020

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Directions to “ MISS TARA LEE BURKETT ” Practice Location

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