Doctor Name: | TARA LYNN RICHARDSON |
NPI Number: | 1023494937 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | 0174641 |
Business Practice Address: | 2469 Corrales Rd Suite E Corrales, NM - 870489146 |
Business Phone Number: | 5058301871 |
Business Fax Number: | |
Mailing Address: | 6200 Eubank Blvd Ne, 1722 ALBUQUERQUE |
State: | NM |
Postal Code: | 871117379 |
Phone Number: | 9898542221 |
Fax Number: | |
NPI Enumeration Date: | 08/03/2015 |
NPI Last Update Date: | 05/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0174641 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |