Provider Demographics
NPI:1801107180
Name:HAYES, TARA YOUNG (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:YOUNG
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-4655
Mailing Address - Country:US
Mailing Address - Phone:979-248-9683
Mailing Address - Fax:
Practice Address - Street 1:1825 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4655
Practice Address - Country:US
Practice Address - Phone:979-248-9683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23037OtherSOCIAL WORK LICENSE