Basic Information
| Provider Information | |||||||||
| NPI: | 1356657761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARENT | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 W MAIN ST | ||||||||
| Address2: | STE A2 | ||||||||
| City: | ARTESIA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882103711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757468890 | ||||||||
| FaxNumber: | 5758879579 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757469848 | ||||||||
| FaxNumber: | 5757469840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | C-09084 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.