Provider Demographics
NPI:1134346968
Name:RICHARDSON, TARA M (PHD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E KATELLA AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5008
Mailing Address - Country:US
Mailing Address - Phone:949-354-3811
Mailing Address - Fax:952-674-9400
Practice Address - Street 1:1500 E KATELLA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:949-354-3811
Practice Address - Fax:952-674-9400
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28685106H00000X
CAPSY17736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist