Provider Demographics
NPI:1396085361
Name:SLUYTER, TARA WINGS
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:WINGS
Last Name:SLUYTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223594
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922-3594
Mailing Address - Country:US
Mailing Address - Phone:831-622-9950
Mailing Address - Fax:
Practice Address - Street 1:6 HANGAR WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2456
Practice Address - Country:US
Practice Address - Phone:831-786-0600
Practice Address - Fax:831-786-0644
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst