Provider Demographics
NPI:1578326393
Name:TARANGO, JAIME A JR (LAC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:A
Last Name:TARANGO
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JJ
Other - Middle Name:
Other - Last Name:TARANGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11105 N 115TH ST APT 2065
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8590 E SHEA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6682
Practice Address - Country:US
Practice Address - Phone:602-540-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-08053T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty