Doctor Name: | TARA C CORONADO |
NPI Number: | 1154783900 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH13941 |
Business Practice Address: | 4700 N State Road 7 Ste 220 Lauderdale Lakes, FL - 333195804 |
Business Phone Number: | 9542946592 |
Business Fax Number: | 9544973857 |
Mailing Address: | 4740 N State Road 7 Ste 201, LAUDERDALE LAKES |
State: | FL |
Postal Code: | 333195839 |
Phone Number: | 9544864005 |
Fax Number: | 9544973857 |
NPI Enumeration Date: | 03/22/2016 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH13941 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |