Healthcare Provider Details

I. General information

NPI: 1225352651
Provider Name (Legal Business Name): TARA L MYERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2010
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E 4TH ST SUITE 245
SANTA ANA CA
92705-3940
US

IV. Provider business mailing address

2030 E 4TH ST SUITE 245
SANTA ANA CA
92705-3940
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-7315
  • Fax:
Mailing address:
  • Phone: 310-770-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1084
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: