MEDICARE: TARA YOMBOR LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH15193	FL

General Provider Information

NPI Number	:	1205475167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA YOMBOR LMHC

Provider Business Mailing Address
First Line	:	545 SW 18TH AVE UNIT 34
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7704
Country	:	US
Telephone Number	:	248-709-9725
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 SW 18TH AVE UNIT 34
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7704
Country	:	US
Telephone Number	:	248-709-9725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2019
Last Update Date	:	12/24/2019

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