MEDICARE: TARAH STOWELL, LCSW, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1447895214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARAH STOWELL, LCSW, LLC

Provider Business Mailing Address
First Line	:	5280 BRIDLE WAY
Second Line	:
City	:	OAKLEY
State	:	UT
Zip	:	84055-2112
Country	:	US
Telephone Number	:	801-243-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2465 KILBY RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-8212
Country	:	US
Telephone Number	:	801-243-9994
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TARAH STOWELL
Credential	:	LCSW
Telephone Number	:	801-243-9994

Provider Enumeration Date	:	11/15/2019
Last Update Date	:	11/15/2019

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