Healthcare Provider Details

I. General information

NPI: 1760393235
Provider Name (Legal Business Name): TARA N HAYMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE DR
SOUTH LAKE TAHOE CA
96150-4500
US

IV. Provider business mailing address

2233 WASHINGTON AVE UNIT A
SOUTH LAKE TAHOE CA
96150-6467
US

V. Phone/Fax

Practice location:
  • Phone: 530-541-4660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: