Provider Demographics
NPI:1467782375
Name:WELLINGTON, TASHA MCMAHON (PHD)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:MCMAHON
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6944
Mailing Address - Country:US
Mailing Address - Phone:512-653-6789
Mailing Address - Fax:
Practice Address - Street 1:701 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6944
Practice Address - Country:US
Practice Address - Phone:512-653-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY 3388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist