Provider Demographics
NPI:1629759998
Name:CRUM, TARA (LPC-A)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 FAIRMONT PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4511
Mailing Address - Country:US
Mailing Address - Phone:281-769-2238
Mailing Address - Fax:281-769-2164
Practice Address - Street 1:6021 FAIRMONT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4511
Practice Address - Country:US
Practice Address - Phone:281-769-2238
Practice Address - Fax:281-769-2164
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional