Healthcare Provider Details

I. General information

NPI: 1588591135
Provider Name (Legal Business Name): TARA LEANN SPEAKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 PONY TRACKS DR
COLORADO SPRINGS CO
80922-1404
US

IV. Provider business mailing address

3165 PONY TRACKS DR
COLORADO SPRINGS CO
80922-1404
US

V. Phone/Fax

Practice location:
  • Phone: 719-766-1103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0014946
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADDC.0000262
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: