Provider Demographics
NPI:1871032268
Name:JOSEPH, TARA (LMFT, ATR)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 N SIERRA BONITA AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2425
Mailing Address - Country:US
Mailing Address - Phone:908-809-0232
Mailing Address - Fax:
Practice Address - Street 1:8730 W SUNSET BLVD STE 550
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2278
Practice Address - Country:US
Practice Address - Phone:323-997-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist