Provider Demographics
NPI:1508886276
Name:DEVINE, TARA COKER (LPC-S, LMFT-S, LCDC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:COKER
Last Name:DEVINE
Suffix:
Gender:F
Credentials:LPC-S, LMFT-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 RALSTON BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4771 SWEETWATER BLVD
Practice Address - Street 2:NO. 173
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3121
Practice Address - Country:US
Practice Address - Phone:281-881-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62839101YM0800X
TX201273106H00000X
TX10528101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME239350099Medicaid
ME079149OtherANTHEM BLUE SHIELD