Healthcare Provider Details

I. General information

NPI: 1356657761
Provider Name (Legal Business Name): TARA N PARENT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 MEMORIAL DR
ARTESIA NM
88210-1189
US

IV. Provider business mailing address

1700 W MAIN ST STE A2
ARTESIA NM
88210-3711
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-9848
  • Fax: 575-746-9840
Mailing address:
  • Phone: 575-746-8890
  • Fax: 575-887-9579

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 Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09084
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: