Provider Demographics
NPI:1316674708
Name:BALL, TARA C
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:C
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:C
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5060 CALIFORNIA AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7073
Mailing Address - Country:US
Mailing Address - Phone:661-258-3240
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:5060 CALIFORNIA AVE STE 610
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7073
Practice Address - Country:US
Practice Address - Phone:661-258-3240
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician