MEDICARE: MS. TARA GALEANO L.P.C.

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	3677	CO

General Provider Information

NPI Number	:	1861516155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA GALEANO L.P.C.

Provider Business Mailing Address
First Line	:	954 NORTH ST
Second Line	:	SUITE 306
City	:	BOULDER
State	:	CO
Zip	:	80304-3419
Country	:	US
Telephone Number	:	303-544-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	954 NORTH ST
Second Line	:	SUITE 306
City	:	BOULDER
State	:	CO
Zip	:	80304-3419
Country	:	US
Telephone Number	:	303-544-1400
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/13/2015

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