Provider Demographics
NPI:1790549863
Name:HARDEN-LEE, TARA LEIGH (BCBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:HARDEN-LEE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:213 BASSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-6405
Mailing Address - Country:US
Mailing Address - Phone:912-381-4518
Mailing Address - Fax:
Practice Address - Street 1:213 BASSWOOD RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31535-6405
Practice Address - Country:US
Practice Address - Phone:912-381-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-64099103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst