Provider Demographics
NPI:1598471039
Name:DOUDY, TARA RAE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RAE
Last Name:DOUDY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 JFK PKWY UNIT 11F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3087
Mailing Address - Country:US
Mailing Address - Phone:970-427-4034
Mailing Address - Fax:
Practice Address - Street 1:3938 JFK PKWY UNIT 11F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3087
Practice Address - Country:US
Practice Address - Phone:970-589-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health