Provider Demographics
NPI:1447895214
Name:TARAH STOWELL, LCSW, LLC
Entity type:Organization
Organization Name:TARAH STOWELL, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-243-9994
Mailing Address - Street 1:5280 BRIDLE WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-2112
Mailing Address - Country:US
Mailing Address - Phone:801-243-9994
Mailing Address - Fax:
Practice Address - Street 1:2465 KILBY RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-8212
Practice Address - Country:US
Practice Address - Phone:801-243-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty