Provider Demographics
NPI:1891358271
Name:STANLEY, TARA SUZANNE (LPCC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SUZANNE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-0454
Mailing Address - Country:US
Mailing Address - Phone:720-276-1302
Mailing Address - Fax:
Practice Address - Street 1:100 ARAPAHOE AVE STE 12
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:720-276-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015737103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling