Provider Demographics
NPI:1033851944
Name:CHACE, TARA HELENA (PHD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:HELENA
Last Name:CHACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 HAMMERLY BLVD APT 168
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-1926
Mailing Address - Country:US
Mailing Address - Phone:281-224-2164
Mailing Address - Fax:
Practice Address - Street 1:2450 FONDREN RD STE 312
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2323
Practice Address - Country:US
Practice Address - Phone:713-789-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39333103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist