| Organization Name: | BRIAN J TARACENA PSYD PC |
| NPI Number: | 1427123082 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN JONES TARACENA (PSYCHOLOGIST) |
| Mailing Address: | 175 N Main St Heber City |
| State: | UT US |
| Postal Code: | 840321606 |
| Phone Number: | 4356544037 |
| Fax Number: | 4356544077 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 49232362501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |