Provider Demographics
NPI:1932829363
Name:TARA LYNN BURKHOLDER PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:TARA LYNN BURKHOLDER PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-516-8492
Mailing Address - Street 1:253 ANN DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6659
Mailing Address - Country:US
Mailing Address - Phone:878-214-1304
Mailing Address - Fax:
Practice Address - Street 1:253 ANN DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6659
Practice Address - Country:US
Practice Address - Phone:878-214-1304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty