Provider Demographics
NPI:1013198365
Name:REED, TARA ALEXIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ALEXIA
Last Name:REED
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:ALEXIA
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28364 S WESTERN AVE # 412
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1434
Mailing Address - Country:US
Mailing Address - Phone:310-418-7470
Mailing Address - Fax:
Practice Address - Street 1:100 W BROADWAY
Practice Address - Street 2:SUITE 5005
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4431
Practice Address - Country:US
Practice Address - Phone:562-284-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA225400000X
CANA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner