Provider Demographics
NPI:1104212638
Name:CROSBY, TARA J
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:J
Last Name:CROSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:J
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:9975 PEACE WAY
Mailing Address - Street 2:#2046
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8256
Mailing Address - Country:US
Mailing Address - Phone:702-885-6656
Mailing Address - Fax:
Practice Address - Street 1:9975 PEACE WAY
Practice Address - Street 2:#2046
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8256
Practice Address - Country:US
Practice Address - Phone:702-885-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst