Provider Demographics
NPI:1821238544
Name:GALLANT, TARA CALVIN (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CALVIN
Last Name:GALLANT
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 1:2880 N GLENCOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2725
Mailing Address - Country:US
Mailing Address - Phone:303-301-5013
Mailing Address - Fax:
Practice Address - Street 1:2880 N GLENCOE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2725
Practice Address - Country:US
Practice Address - Phone:303-301-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-21
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7941101YM0800X
CO4788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health