Provider Demographics
NPI:1225352651
Name:MYERS, TARA L (LPCC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E 4TH ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3940
Mailing Address - Country:US
Mailing Address - Phone:310-770-7315
Mailing Address - Fax:
Practice Address - Street 1:2030 E 4TH ST
Practice Address - Street 2:SUITE 245
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3940
Practice Address - Country:US
Practice Address - Phone:310-770-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA1084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist