Provider Demographics
NPI:1972795409
Name:SYLVESTER, TARA L (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 HIGH SIERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-5411
Mailing Address - Country:US
Mailing Address - Phone:406-855-6034
Mailing Address - Fax:406-494-1724
Practice Address - Street 1:1860 HIGH SIERRA BLVD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-5411
Practice Address - Country:US
Practice Address - Phone:406-855-6034
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1031OtherSTATE OF MONTANA