| NPI | 1417670670 |
|---|---|
| Former Name | TARA JEAN HOVERSTAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 1752) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC PSY1752) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-09-30 |