Healthcare Provider Details

I. General information

NPI: 1013198365
Provider Name (Legal Business Name): TARA ALEXIA REED PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TARA ALEXIA EPPS

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W BROADWAY SUITE 5005
LONG BEACH CA
90802-4431
US

IV. Provider business mailing address

28364 S WESTERN AVE # 412
RANCHO PALOS VERDES CA
90275-1434
US

V. Phone/Fax

Practice location:
  • Phone: 562-284-0108
  • Fax:
Mailing address:
  • Phone: 310-418-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: