Healthcare Provider Details

I. General information

NPI: 1033851944
Provider Name (Legal Business Name): TARA HELENA ABBOTT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 RED ROCK RANCH RD
RED ROCK TX
78662-4535
US

IV. Provider business mailing address

481 RED ROCK RANCH RD
RED ROCK TX
78662-4535
US

V. Phone/Fax

Practice location:
  • Phone: 281-224-2164
  • Fax:
Mailing address:
  • Phone: 281-224-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number39333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: