Provider Demographics
NPI:1427123082
Name:BRIAN J TARACENA PSYD PC
Entity type:Organization
Organization Name:BRIAN J TARACENA PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:TARACENA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:435-654-4037
Mailing Address - Street 1:175 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1606
Mailing Address - Country:US
Mailing Address - Phone:435-654-4037
Mailing Address - Fax:435-654-4077
Practice Address - Street 1:175 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1606
Practice Address - Country:US
Practice Address - Phone:435-654-4037
Practice Address - Fax:435-654-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49232362501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty