Provider Demographics
NPI:1740444884
Name:THOMAS, TARA LEE (LPCC)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEE
Other - Last Name:PASQUALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-459-6980
Mailing Address - Fax:505-272-1943
Practice Address - Street 1:1001 YALE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3825
Practice Address - Country:US
Practice Address - Phone:505-272-2890
Practice Address - Fax:505-272-1943
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0112821101YM0800X
NM0145061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health