MEDICARE: TARA L. NOWLING

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
1	106H00000X	Marriage & Family Therapist	IMF 39815	CA

General Provider Information

NPI Number	:	1326152497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA L. NOWLING

Provider Business Mailing Address
First Line	:	4612 ROSEVILLE RD STE 107
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5175
Country	:	US
Telephone Number	:	916-344-0199
Fax Number	:	916-344-0196

Provider Business Practice Location Address
First Line	:	4612 ROSEVILLE RD STE 107
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5175
Country	:	US
Telephone Number	:	916-344-0199
Fax Number	:	916-344-0196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	02/11/2022

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