Provider Demographics
NPI:1700838026
Name:BORDELON, TARA D (MSW, LCSW, BACS)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:D
Last Name:BORDELON
Suffix:
Gender:F
Credentials:MSW, LCSW, BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PECAN ROW LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-8711
Mailing Address - Country:US
Mailing Address - Phone:318-730-9598
Mailing Address - Fax:
Practice Address - Street 1:4012 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3017
Practice Address - Country:US
Practice Address - Phone:318-290-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8142104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker