Provider Demographics
NPI:1023494937
Name:RICHARDSON, TARA LYNN (LMHC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 EUBANK BLVD NE
Mailing Address - Street 2:1722
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7379
Mailing Address - Country:US
Mailing Address - Phone:989-854-2221
Mailing Address - Fax:
Practice Address - Street 1:2469 CORRALES RD
Practice Address - Street 2:SUITE E
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9146
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0174641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health