Individual
TARA RAYVONTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSS. B.S. FPSS
Contact information
Practice address
PO BOX 754, PAUL, ID 83347-0754
(208) 878-8887
(208) 878-6888
Mailing address
PO BOX 754, PAUL, ID 83347-0754
(208) 878-8887
(208) 878-6888
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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