Provider Demographics
NPI:1295067288
Name:PACE, TARA ANN (MS, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:PACE
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1215
Mailing Address - Country:US
Mailing Address - Phone:716-896-6388
Mailing Address - Fax:716-894-3088
Practice Address - Street 1:128 WILSON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1215
Practice Address - Country:US
Practice Address - Phone:716-896-6388
Practice Address - Fax:716-894-3088
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY18 004668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)