Provider Demographics
NPI:1740827708
Name:ANDERSON, TARASA
Entity type:Individual
Prefix:
First Name:TARASA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 HIGHWAY 90 STE 200
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-2205
Mailing Address - Country:US
Mailing Address - Phone:985-785-4451
Mailing Address - Fax:985-785-4459
Practice Address - Street 1:12715 HIGHWAY 90 STE 200
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-2205
Practice Address - Country:US
Practice Address - Phone:985-785-4451
Practice Address - Fax:985-785-4459
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health