Provider Demographics
NPI:1801228150
Name:TARA ROMERO
Entity Type:Organization
Organization Name:TARA ROMERO
Other - Org Name:MOSAIC MENTAL & BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS DEGREE
Authorized Official - Phone:702-738-2482
Mailing Address - Street 1:5160 S EASTERN AVE
Mailing Address - Street 2:STE C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2300
Mailing Address - Country:US
Mailing Address - Phone:702-738-2482
Mailing Address - Fax:
Practice Address - Street 1:5160 S EASTERN AVE
Practice Address - Street 2:STE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2300
Practice Address - Country:US
Practice Address - Phone:702-738-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131357483251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health