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NPI Code Detail

MEDICARE: TARA MCDANIEL M.A., LMFT

MEDICARE: TARA MCDANIEL M.A., LMFT
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
1101YM0800XMental Health Counselor
2106H00000XMarriage & Family TherapistLMFT77112CA
31041C0700XClinical Social Worker

General Provider Information

NPI Number : 1699958686
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA MCDANIEL M.A., LMFT
Provider Business Mailing Address
First Line : PO BOX 6003
Second Line :
City : VENTURA
State : CA
Zip : 93006-6003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 CALLE TECATE STE 201
Second Line :
City : CAMARILLO
State : CA
Zip : 93012-5056
Country : US
Telephone Number : 805-289-0120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2007
Last Update Date : 12/27/2023

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