Healthcare Provider Details

I. General information

NPI: 1891308086
Provider Name (Legal Business Name): TARA A HAYS LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW HIGGINS AVE
MISSOULA MT
59803-1495
US

IV. Provider business mailing address

PO BOX 508
LOLO MT
59847-0508
US

V. Phone/Fax

Practice location:
  • Phone: 406-396-4130
  • Fax: 406-797-5008
Mailing address:
  • Phone: 406-219-1112
  • Fax: 406-797-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44112
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: