Healthcare Provider Details

I. General information

NPI: 1063714533
Provider Name (Legal Business Name): TARA ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5652 SALT ROCK ST
NORTH LAS VEGAS NV
89031-1309
US

IV. Provider business mailing address

2535 W CHEYENNE AVE STE 102
NORTH LAS VEGAS NV
89032-8930
US

V. Phone/Fax

Practice location:
  • Phone: 702-738-2482
  • Fax:
Mailing address:
  • Phone: 702-631-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI5555
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: