Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003162900 |
---|---|
Provider Name | Galina Alexandrovma Tarasova |
First Address | Pahrump, NV 89060-2511 |
Second Address | Pahrump, NV 89060-2511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2012 |
Last Update Date | 28/07/2012 |