Provider Demographics
NPI:1629784558
Name:DAVIDSON, TARA WHITNEY (MA, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:WHITNEY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MA, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7896 QUERIDA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3151
Mailing Address - Country:US
Mailing Address - Phone:214-364-6811
Mailing Address - Fax:
Practice Address - Street 1:5445 LA SIERRA DR STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4137
Practice Address - Country:US
Practice Address - Phone:214-706-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86174OtherTEXAS LICENSED PROFESSIONAL COUNSELOR ASSOCIATE NUMBER