Provider Demographics
NPI:1568071264
Name:BARGE, TYARA (LCSW)
Entity Type:Individual
Prefix:
First Name:TYARA
Middle Name:
Last Name:BARGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 FELICE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4222
Mailing Address - Country:US
Mailing Address - Phone:832-725-8428
Mailing Address - Fax:
Practice Address - Street 1:600 S AUSTIN RD
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:TX
Practice Address - Zip Code:77434-3202
Practice Address - Country:US
Practice Address - Phone:979-234-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical