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General NPI Number Information
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NPI Number | 1669720678
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Entity Type | Individual
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Provider Name | MRS. TARA ASHLEY HANNA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 3652 N. RANCHO DRIVE #102
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City | N. LAS VEGAS
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State | NV
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Zip | 89130-3180
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Country | US
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Telephone | 702-334-6162
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Fax |
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Provider Business Mailing Address
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Address Line | 9373 WILD LARIAT AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-5522
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Country | US
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Telephone | 702-340-1322
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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 | MI0475
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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