Provider Demographics
NPI:1760065510
Name:MERIDA, TARA (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MERIDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 TURTLE COVE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-5499
Mailing Address - Country:US
Mailing Address - Phone:832-289-0895
Mailing Address - Fax:
Practice Address - Street 1:3630 TURTLE COVE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-5499
Practice Address - Country:US
Practice Address - Phone:832-289-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional