Provider Demographics
NPI:1568759827
Name:GILMAHER, TARA (MA, CA LMFT#121152)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GILMAHER
Suffix:
Gender:F
Credentials:MA, CA LMFT#121152
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MONTROSE AVE # 294
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1508
Mailing Address - Country:US
Mailing Address - Phone:818-749-3583
Mailing Address - Fax:
Practice Address - Street 1:119 FIGUEROA ST # 1
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2756
Practice Address - Country:US
Practice Address - Phone:818-749-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT93790106H00000X
CA6653 DONA INTERNATL374J00000X
CA121152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty