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General NPI Number Information
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NPI Number | 1366872707
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Entity Type | Individual
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Provider Name | TARALEE LASHWAY
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Gender | Female
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 11050 MT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-2603
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Country | US
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Telephone | 315-772-3778
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Fax |
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Provider Business Mailing Address
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Address Line | P36 FIRST STREET W
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City | FORT DRUM
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State | NY
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Zip | 13602-2603
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Country | US
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Telephone | 315-772-3778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 31808
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001079
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License Number State | NY
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