Provider Demographics
NPI:1003323437
Name:MUKORO, TARA SHANETT (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:SHANETT
Last Name:MUKORO
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 SAWMILL BEND LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1261
Mailing Address - Country:US
Mailing Address - Phone:713-884-7235
Mailing Address - Fax:281-239-2838
Practice Address - Street 1:5802 SAWMILL BEND LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1261
Practice Address - Country:US
Practice Address - Phone:713-884-7235
Practice Address - Fax:281-239-2838
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74850101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional