Provider Demographics
NPI:1952928103
Name:CAMBRON, TARAH CHANNAN (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:CHANNAN
Last Name:CAMBRON
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20103 INDIGO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-4130
Mailing Address - Country:US
Mailing Address - Phone:713-249-1793
Mailing Address - Fax:
Practice Address - Street 1:15860 OLD CONROE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3485
Practice Address - Country:US
Practice Address - Phone:713-249-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health