Basic Information
| Provider Information | |||||||||
| NPI: | 1962594218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEYFERT | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 W 600 N | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840783606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357256300 | ||||||||
| FaxNumber: | 4357256325 | ||||||||
| Practice Location | |||||||||
| Address1: | 7510 91ST AVE | ||||||||
| Address2: | |||||||||
| City: | WOODHAVEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114212824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182962871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6683335-3506 | UT | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | SW9912 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1962594218 | 01 | LCSW | OTHER |