Provider Demographics
NPI:1114158052
Name:ALLEN, TARA (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 N GILBERT RD
Mailing Address - Street 2:STE 124-313
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3375
Mailing Address - Country:US
Mailing Address - Phone:480-228-1400
Mailing Address - Fax:
Practice Address - Street 1:745 N. GILBERT RD
Practice Address - Street 2:STE 124313
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-228-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ264150463OtherGROUP NPI NUMBER