Provider Demographics
NPI:1104398718
Name:VARGAS-TUCKER, TARA JERRAY (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:JERRAY
Last Name:VARGAS-TUCKER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:SD
Mailing Address - Zip Code:57555-0105
Mailing Address - Country:US
Mailing Address - Phone:605-856-8239
Mailing Address - Fax:605-856-8124
Practice Address - Street 1:101 ANTELOPE CIRCLE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555-5755
Practice Address - Country:US
Practice Address - Phone:605-856-8239
Practice Address - Fax:605-856-8124
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional