MEDICARE: TARRA CLINEFELTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497133755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARRA CLINEFELTER

Provider Business Mailing Address
First Line	:	1714 SHEA CENTER DR APT 101
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-3524
Country	:	US
Telephone Number	:	303-797-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 SHEA CENTER DR APT 101
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-3524
Country	:	US
Telephone Number	:	303-797-9440
Fax Number	:

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

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	05/07/2015

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Directions to “ TARRA CLINEFELTER ” Practice Location

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