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General NPI Number Information
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NPI Number | 1578326393
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Entity Type | Individual
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Provider Name | JAIME A TARANGO JR. LAC
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Gender | Male
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 8590 E SHEA BLVD STE 130
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6682
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Country | US
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Telephone | 602-540-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 11105 N 115TH ST APT 2065
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-4027
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-08053T
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License Number State | AZ
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