Provider Demographics
NPI:1922262138
Name:HRUBY, TARA P (LMHC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:P
Last Name:HRUBY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:P
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1101 NE 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1414
Mailing Address - Country:US
Mailing Address - Phone:239-699-8622
Mailing Address - Fax:
Practice Address - Street 1:1639 CAPE CORAL PKWY E
Practice Address - Street 2:STE 211
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904
Practice Address - Country:US
Practice Address - Phone:239-699-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health